Department of Environmental and Occupational Health, National Cheng Kung University College of Medicine, Tainan, Taiwan.
Pediatr Allergy Immunol. 2011 Nov;22(7):695-703. doi: 10.1111/j.1399-3038.2011.01177.x. Epub 2011 May 4.
Atopic dermatitis (AD) is the most common skin disease in childhood and the first step of atopic march. This study aimed to investigate whether AD in children could be better predicted by biologic markers (cord blood IgE [cbIgE], LT-αNcoI alleles, and FcεRI-β E237G genotypes) and maternal mentality during pregnancy, taking into account gender, socio-demographic factors, and parental atopy. From 2001 to 2005, 1264 mother-infant pairs were recruited to participate in a birth cohort study. Prenatal questionnaire was used to collect family history, maternal gestational conditions and mentality, and environmental exposures. Cord blood was collected and assayed for genotypes and IgE levels. Phone interviews at 6 months and 2 yrs of age were conducted to inquire children's health status, including AD occurrence. In addition to the known risk factors such as gender, maternal education, and parental atopy, biomarkers and maternal mentality during pregnancy were screened by logistic regression as candidate predictors of AD. Area-under-curve (AUC) statistic from receiver-operating characteristic (ROC) curve analysis was used to compare two predicting models with and without biomarkers and maternal mentality. A total of 730 pairs completed the prenatal questionnaire and phone interview and were included in final analysis. The prevalence of ever having physician-diagnosed AD by 2-yr-olds was 5.9%. Elevated cbIgE levels (≥0.5 kU/l), LT-αNcoI alleles, FcεRI-β E237G genotype, and maternal psychologic stress during pregnancy were significantly associated with AD. Comparison with AUCs of the classic model (including gender, maternal education, and parental atopy), the model adding cbIgE levels, genotypes in cytokine genes, and maternal stress (model 2) showed higher ability to discriminate between children with and without AD (AUC statistics: 0.63 [95% CI = 0.60-0.67] vs. 0.73 [95% CI = 0.70-0.76], respectively; model comparison, p = 0.027). We conclude that elevated cbIgE, LT-α and FcεRI-β genotypes, and maternal stress during pregnancy were associated with ever having physician-diagnosed AD in 2-yr-old children and increased the predictive ability for AD after taking into account gender, maternal education, and parental atopic history.
特应性皮炎（AD）是儿童中最常见的皮肤病，也是特应性进行曲的第一步。本研究旨在探讨生物标志物（脐带血 IgE[cbIgE]、LT-αNcoI 等位基因和 FcεRI-βE237G 基因型）和母亲在怀孕期间的心理状况是否可以更好地预测儿童 AD，同时考虑性别、社会人口因素和父母过敏情况。2001 年至 2005 年，招募了 1264 对母婴对参与出生队列研究。使用产前问卷收集家族史、母亲妊娠情况和心理状况以及环境暴露情况。采集脐带血并检测基因型和 IgE 水平。在 6 个月和 2 岁时进行电话访谈，询问儿童健康状况，包括 AD 发生情况。除了性别、母亲教育程度和父母过敏等已知危险因素外，生物标志物和母亲在怀孕期间的心理状况还通过逻辑回归筛选为 AD 的候选预测因素。接收器工作特性（ROC）曲线分析的曲线下面积（AUC）统计用于比较包含和不包含生物标志物和母亲心理状况的两个预测模型。共有 730 对完成了产前问卷和电话访谈，并纳入最终分析。2 岁时曾被医生诊断为 AD 的比例为 5.9%。脐带血中 IgE 水平升高（≥0.5kU/L）、LT-αNcoI 等位基因、FcεRI-βE237G 基因型和母亲在怀孕期间的心理压力与 AD 显著相关。与经典模型（包括性别、母亲教育程度和父母过敏）的 AUC 相比，添加 cbIgE 水平、细胞因子基因基因型和母亲压力的模型（模型 2）在区分 AD 患儿和非 AD 患儿方面具有更高的能力（AUC 统计数据：0.63[95%CI=0.60-0.67]vs.0.73[95%CI=0.70-0.76]；模型比较，p=0.027）。我们的结论是，脐带血中 IgE、LT-α 和 FcεRI-β 基因型升高以及母亲怀孕期间的压力与 2 岁时被医生诊断为 AD 有关，并在考虑性别、母亲教育程度和父母过敏史后增加了 AD 的预测能力。
