Department of Dermato-venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Arch Dermatol Res. 2019 Apr;311(3):173-182. doi: 10.1007/s00403-019-01895-z. Epub 2019 Feb 15.
We aimed to explore the association of key clinical characteristics with disease severity in atopic dermatitis (AD) and its relation to components of the atopic march in a large hospital cohort. Outpatients with AD referred to the Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark, between January 2012 and December 2017, were compared based on disease severity (SCORAD); mild (< 25), moderate (25-50) and severe (> 50). A total of 470 AD patients were included: 122 small children (< 4 years of age), 103 children/adolescents (age 4-15 years) and 245 adults (> 15 years of age). A significant difference between severity groups in small children was observed for FLG mutation carrier status (16.7 vs. 30.2 vs. 60.0% mutation carriers among patients with mild, moderate and severe AD, respectively, p = 0.012) and self-rated health (3.2 vs. 2.7 vs. 2.8 with 4 being excellent health, p = 0.022). A significant difference between severity groups in adults was observed for male sex (24.4 vs. 39.8 vs. 52.9%, p = 0.003), serum total IgE (577 vs. 1269 vs. 2379 × 10 IU/L, p < 0.001), blood eosinophil count (0.28 vs. 0.39 vs. 0.61 × 10/L, p < 0.001) and asthma (42.9 vs. 38.8 vs. 72.0%, p < 0.001). Early onset of AD (< 1 year of age) and FLG mutation was associated with more severe disease and high serum total IgE levels. In conclusion, the distribution of key clinical characteristics varies significantly according to the severity of AD measured by SCORAD. Sub-typing of AD patients related to determinants of disease severity may be helpful in establishing prognosis and targeted treatment of AD.
我们旨在探讨特应性皮炎（AD）的关键临床特征与疾病严重程度的相关性，以及其与特应性进程各组成部分的关系，该研究基于丹麦哥本哈根比耶比厄格医院皮肤科的一个大型队列。2012 年 1 月至 2017 年 12 月期间，将被转诊至皮肤科的 AD 门诊患者根据疾病严重程度（SCORAD）进行比较；轻度（<25）、中度（25-50）和重度（>50）。共纳入 470 例 AD 患者：122 例为幼儿（<4 岁）、103 例为儿童/青少年（4-15 岁）和 245 例为成年人（>15 岁）。在幼儿中，严重程度组之间存在显著差异，表现为 FLG 突变携带者状态（轻度、中度和重度 AD 患者中分别有 16.7%、30.2%和 60.0%为突变携带者，p=0.012）和自我报告的健康状况（4 分为非常好，分别为 3.2、2.7 和 2.8，p=0.022）。在成年人中，严重程度组之间存在显著差异，表现为男性（24.4%、39.8%和 52.9%，p=0.003）、血清总 IgE（577、1269 和 2379×10IU/L，p<0.001）、血嗜酸性粒细胞计数（0.28、0.39 和 0.61×10/L，p<0.001）和哮喘（42.9%、38.8%和 72.0%，p<0.001）。AD 的早期发病（<1 岁）和 FLG 突变与更严重的疾病和高血清总 IgE 水平相关。总之，根据 SCORAD 评估的 AD 严重程度，关键临床特征的分布存在显著差异。与疾病严重程度决定因素相关的 AD 患者亚分型可能有助于确立 AD 的预后和靶向治疗。
