Hu C, Duijts L, Erler N S, Elbert N J, Piketty C, Bourdès V, Blanchet-Réthoré S, de Jongste J C, Pasmans S G M A, Felix J F, Nijsten T
The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Br J Dermatol. 2019 Dec;181(6):1190-1197. doi: 10.1111/bjd.17879. Epub 2019 Jul 30.
Childhood eczema is variable in onset and persistence.
To identify eczema phenotypes during childhood, and their associations with early-life environmental and genetic factors.
In this study of 5297 children from a multiethnic population-based prospective cohort study, phenotypes based on parent-reported physician-diagnosed eczema from age 6 months to 10 years were identified using latent class growth analysis. Information on environmental factors was obtained using postal questionnaires. Four filaggrin mutations were genotyped and a risk score was calculated based on 30 genetic variants. Weighted adjusted multinomial models were used for association analyses.
We identified the following five eczema phenotypes: never (76%), early transient (8%), mid-transient (6%) and late transient (8%) and persistent eczema (2%). Early transient and persistent eczema were most common in first-born children, those with a parental history of eczema, allergy or asthma and those with persistent wheezing [range of odds ratio (OR): 1.37, 95% confidence interval (CI) 1.07-1.74 and OR 3.38, 95%CI 1.95-5.85]. Early transient eczema was most common in male children only (OR 1·49, 95% CI 1·18-1·89). Children with late transient or persistent eczema were more often of Asian ethnicity (OR 2·04, 95% CI 1·14-3·65 and OR 3·08, 95% CI 1·34-7·10, respectively). Children with early, late transient and persistent eczema more often had a filaggrin mutation or additional risk alleles (range OR: 1.07, 95%CI 1.02-1.12 and OR 2.21, 95%CI 1.39-3.50). Eczema phenotypes were not associated with maternal education, breastfeeding, day care attendance and pet exposure.
Five eczema phenotypes were identified in a multiethnic paediatric population with limited differences in risk profiles, except for sex and ethnicity. What's already known about this topic? Two previous studies in longitudinal birth cohorts identified four and six different eczema phenotypes, predominantly in children of European ethnicity. What does this study add? Five eczema phenotypes were identified in a multiethnic paediatric population using latent class growth analysis. Children with early transient and persistent eczema were most often first-born children and had persistent wheezing, filaggrin mutation or additional risk alleles. Previously known eczema risk factors had limited differentiating capabilities for eczema phenotypes, except for the association of early transient eczema with male children, and late transient and persistent eczema with Asian ethnicity.
儿童湿疹在发病和持续时间上具有多样性。
确定儿童期湿疹的表型及其与早期环境和遗传因素的关联。
在这项基于多民族人群的前瞻性队列研究中，对5297名儿童进行了研究，使用潜在类别生长分析确定了基于家长报告的6个月至10岁医生诊断的湿疹表型。通过邮寄问卷获得环境因素信息。对四个丝聚合蛋白突变进行基因分型，并根据30个基因变异计算风险评分。使用加权调整多项模型进行关联分析。
我们确定了以下五种湿疹表型：从未患湿疹（76%）、早期短暂性湿疹（8%）、中期短暂性湿疹（6%）、晚期短暂性湿疹（8%）和持续性湿疹（2%）。早期短暂性和持续性湿疹在头胎儿童、有湿疹、过敏或哮喘家族史的儿童以及有持续性喘息的儿童中最为常见[优势比（OR）范围：1.37，95%置信区间（CI）1.07 - 1.74；OR 3.38，95%CI 1.95 - 5.85]。早期短暂性湿疹仅在男性儿童中最为常见（OR 1.49，95%CI 1.18 - 1.89）。晚期短暂性或持续性湿疹的儿童更常为亚洲种族（分别为OR 2.04，95%CI 1.14 - 3.65和OR 3.08，95%CI 1.34 - 7.10）。早期、晚期短暂性和持续性湿疹的儿童更常发生丝聚合蛋白突变或携带额外的风险等位基因（OR范围：1.07，95%CI 1.02 - 1.12；OR 2.21，95%CI 1.39 - 3.50）。湿疹表型与母亲教育程度、母乳喂养、日托出勤情况和宠物接触无关。
在一个多民族儿科人群中确定了五种湿疹表型，除性别和种族外，风险特征差异有限。关于该主题已知的信息有哪些？之前两项纵向出生队列研究确定了四种和六种不同的湿疹表型，主要见于欧洲种族儿童。本研究增加了什么？使用潜在类别生长分析在一个多民族儿科人群中确定了五种湿疹表型。早期短暂性和持续性湿疹的儿童最常是头胎儿童，并有持续性喘息、丝聚合蛋白突变或额外的风险等位基因。除了早期短暂性湿疹与男性儿童、晚期短暂性和持续性湿疹与亚洲种族的关联外，先前已知的湿疹风险因素对湿疹表型的区分能力有限。
