Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2019 Dec;81(6):1292-1299. doi: 10.1016/j.jaad.2019.05.016. Epub 2019 May 11.
Wide variation exists in the timing of atopic dermatitis (AD) disease onset among children. Distinct trajectories of early-onset, mid-onset, and late-onset AD have been previously described.
To evaluate longitudinal disease control and persistence with respect to age at onset of AD.
A cohort study was performed using the Pediatric Eczema Elective Registry, a prospective observational cohort of subjects with childhood-onset AD. AD control and persistence were assessed biannually for up to 10 years.
A total of 8015 subjects with 41,934 person-years of follow-up were included. In longitudinal analyses using generalized linear latent and mixed modeling, older age at onset of AD was associated with better disease control and less-persistent AD. For each additional year of age at onset of AD, the adjusted odds ratios for poorer AD control and for persistent AD were 0.93 (95% confidence interval, 0.91-0.94) and 0.84 (95% confidence interval, 0.80-0.88), respectively. Differences in AD control and persistence among subjects with early-, mid-, and late-onset AD were most pronounced from early adolescence onward.
Misclassification bias may arise from using self-reported data on age at onset. Attrition and missing data in longitudinal studies may introduce bias.
Early-, mid-, and late-onset pediatric AD appear to be clinically distinct subtypes of the disease.
儿童特应性皮炎（AD）的发病时间存在广泛的差异。先前已经描述了特应性皮炎的早期发病、中期发病和晚期发病的不同轨迹。
评估特应性皮炎发病年龄与疾病控制和持续性的关系。
本研究使用儿科特应性皮炎选择性登记处（一项针对儿童期特应性皮炎患者的前瞻性观察队列研究）进行了一项队列研究。在长达 10 年的时间里，每两年评估一次 AD 的控制和持续性。
共纳入 8015 名患者，随访 41934 人年。使用广义线性潜在和混合模型进行纵向分析，AD 发病年龄越大，疾病控制越好，AD 持续时间越短。AD 发病年龄每增加 1 岁，AD 控制不佳的调整比值比和持续 AD 的调整比值比分别为 0.93（95%置信区间，0.91-0.94）和 0.84（95%置信区间，0.80-0.88）。从青少年早期开始，早发、中发和晚发 AD 患者在 AD 控制和持续性方面的差异最为明显。
发病年龄的自我报告数据可能存在分类偏倚。纵向研究中的失访和缺失数据可能会产生偏差。
早发、中发和晚发儿童 AD 似乎是该疾病的临床不同亚型。
