1岁前呼吸道与非呼吸道症状对学龄期哮喘的预测价值
2025/04/06
摘要
背景：最新研究提示哮喘起源可追溯至产前及生命早期暴露。实施针对性干预需在婴儿期识别哮喘高风险人群。本研究旨在通过生命首年呼吸道与非呼吸道疾病的综合症状体征指标预测儿童期哮喘。
方法："婴儿免疫研究"纳入妊娠晚期孕妇，通过基线调查与多次随访收集父母哮喘史、婴儿症状数据及儿童期哮喘诊断。采用多重对应分析法（MCA）对6月龄和9月龄的11种呼吸道与非呼吸道症状进行降维处理，将潜在维度纳入多因素logistic回归模型预测儿童期哮喘。通过偏倚校正布雷尔分数（Brier score）、受试者工作特征曲线下面积（AUC）及预测效能曲线评估模型区分度与校准度。
结果：393名数据完整的婴儿（占入组人群82%）中，17%发展为哮喘。预测模型显示：与症状数量相关的潜在维度（解释为疾病严重程度）可预测后续哮喘发生；另有2个独立症状维度具有预测价值，其一以喘息和湿疹为特征，另一与腹泻、呕吐相关。偏倚校正后布雷尔分数为0.136（提示优异预测效能），AUC达0.71（95%CI=0.64-0.78）。
结论：生命首年呼吸道症状体征的严重程度可能是哮喘风险的早期临床表征。该风险还可能与独立于喘息的疾病机制相关，涉及气道与胃肠功能失调。
Respiratory and nonrespiratory symptoms before age 1 year predict school-age asthma
Rabe BA, Stern DA, Carr TF, Billheimer D, Martinez FD
Abstract
BACKGROUND:New research traces the origins of asthma to prenatal and early-life exposures. Targeted interventions require early identification of infants who are at increased risk of asthma. We aimed to use a composite measure of symptoms and related signs of respiratory and nonrespiratory illness collected in the first year of life to predict childhood asthma.
METHODS:The Infant Immune Study enrolled pregnant women in their third trimester. Data on parental asthma, infant symptom data, and childhood asthma were collected at enrollment and over repeated visits. We applied multiple correspondence analysis to reduce the dimensionality of 11 respiratory and nonrespiratory symptoms at ages 6 and 9 months. Latent dimensions were used in a multivariable logistic regression model of childhood asthma. Bias-corrected Brier scores, area under the receiver operating characteristic curve statistics, and predictiveness curves assessed model discrimination and calibration.
RESULTS:Of the 393 enrolled infants with complete data (82%), 17% developed asthma. Predictive model estimates showed that a latent dimension associated with the number of symptoms reported-interpreted as the intensity of illness-was predictive of subsequent asthma. Additionally, 2 other independent symptom dimensions were predictive: one characterized by wheezing and eczema and the other associated with diarrhea and vomiting. The bias-corrected Brier score was 0.136, indicating excellent predictive performance, and the area under the receiver operating characteristic curve was 0.71 (95% CI = 0.64-0.78).
CONCLUSION:Intensity of respiratory signs and symptoms during the first year of life may be an early clinical expression of asthma risk. This risk could also be associated with disease mechanisms distinct from those causing wheezing and related to airway and gastrointestinal dysfunction.
背景：最新研究提示哮喘起源可追溯至产前及生命早期暴露。实施针对性干预需在婴儿期识别哮喘高风险人群。本研究旨在通过生命首年呼吸道与非呼吸道疾病的综合症状体征指标预测儿童期哮喘。
方法："婴儿免疫研究"纳入妊娠晚期孕妇，通过基线调查与多次随访收集父母哮喘史、婴儿症状数据及儿童期哮喘诊断。采用多重对应分析法（MCA）对6月龄和9月龄的11种呼吸道与非呼吸道症状进行降维处理，将潜在维度纳入多因素logistic回归模型预测儿童期哮喘。通过偏倚校正布雷尔分数（Brier score）、受试者工作特征曲线下面积（AUC）及预测效能曲线评估模型区分度与校准度。
结果：393名数据完整的婴儿（占入组人群82%）中，17%发展为哮喘。预测模型显示：与症状数量相关的潜在维度（解释为疾病严重程度）可预测后续哮喘发生；另有2个独立症状维度具有预测价值，其一以喘息和湿疹为特征，另一与腹泻、呕吐相关。偏倚校正后布雷尔分数为0.136（提示优异预测效能），AUC达0.71（95%CI=0.64-0.78）。
结论：生命首年呼吸道症状体征的严重程度可能是哮喘风险的早期临床表征。该风险还可能与独立于喘息的疾病机制相关，涉及气道与胃肠功能失调。
（中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校）
（J Allergy Clin Immunol. 2025 Feb 26; DOI: 10.1016/j.jaci.2025.02.023）
Respiratory and nonrespiratory symptoms before age 1 year predict school-age asthma
Rabe BA, Stern DA, Carr TF, Billheimer D, Martinez FD
Abstract
BACKGROUND:New research traces the origins of asthma to prenatal and early-life exposures. Targeted interventions require early identification of infants who are at increased risk of asthma. We aimed to use a composite measure of symptoms and related signs of respiratory and nonrespiratory illness collected in the first year of life to predict childhood asthma.
METHODS:The Infant Immune Study enrolled pregnant women in their third trimester. Data on parental asthma, infant symptom data, and childhood asthma were collected at enrollment and over repeated visits. We applied multiple correspondence analysis to reduce the dimensionality of 11 respiratory and nonrespiratory symptoms at ages 6 and 9 months. Latent dimensions were used in a multivariable logistic regression model of childhood asthma. Bias-corrected Brier scores, area under the receiver operating characteristic curve statistics, and predictiveness curves assessed model discrimination and calibration.
RESULTS:Of the 393 enrolled infants with complete data (82%), 17% developed asthma. Predictive model estimates showed that a latent dimension associated with the number of symptoms reported-interpreted as the intensity of illness-was predictive of subsequent asthma. Additionally, 2 other independent symptom dimensions were predictive: one characterized by wheezing and eczema and the other associated with diarrhea and vomiting. The bias-corrected Brier score was 0.136, indicating excellent predictive performance, and the area under the receiver operating characteristic curve was 0.71 (95% CI = 0.64-0.78).
CONCLUSION:Intensity of respiratory signs and symptoms during the first year of life may be an early clinical expression of asthma risk. This risk could also be associated with disease mechanisms distinct from those causing wheezing and related to airway and gastrointestinal dysfunction.
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预测未控制型哮喘未来急性加重：基于大规模临床蛋白质组学的探索/验证方法
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每日步数与成人哮喘发病率的关系
