Oloyede Iso Precious, Ullah Anhar, Murray Clare S, Fontanella Sara, Simpson Angela, Custovic Adnan
National Heart and Lung Institute, Imperial College London, London, UK.
Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
Pediatr Allergy Immunol. 2024 Dec;35(12):e70013. doi: 10.1111/pai.70013.
Wheezing is common in early life, but most children stop wheezing by school age. However, the prediction of course of wheezing through childhood is difficult.
To investigate whether urinary EPX (a marker of eosinophil activation) in children at age 3 years may be useful for the prediction of wheeze persistence and future asthma diagnosis.
U-EPX was measured at age 3 years (radioimmunoassay) in 906 participants in the population-based birth cohort. Children attended follow-ups to age 16 years. We investigate the discriminative ability of u-EPX and other factors in predicting asthma diagnosis at age 16 using receiver operating characteristic [ROC] curves.
Of 613 children with follow-up information at age 16, 511 had data on u-EPX at age 3 and asthma diagnosis at age 16 years; of those; 133 (21.7%) had asthma. Based on longitudinal data, children were assigned to wheeze clusters: No wheeze (NWZ), early transient (ETW), late-onset (LOW), intermittent (INT) and persistent wheeze (PEW). U-EPX levels differed significantly between different wheeze clusters (p = .003), with clusters characterised with persistent symptoms having higher u-EPX. In the whole cohort, the best performing classification model for asthma diagnosis at age 16 years included sex, u-EPX, sensitisation and wheeze (area under the curve (AUC) = 0.82, 95% CI: 0.76-0.88). u-EPX and allergic sensitisation alone had similar predictive power (AUC [95%CI]: 0.64 [0.58-0.71] and 0.65 [0.60-0.71]). The best performing classification model for asthma prediction among children with doctor-confirmed wheeze in the first 3 years included child's u-EPX and sensitisation at age 3 years, sex, gestational age and maternal atopy (AUC: 0.76, 95%CI: 0.67-0.85).
Early-life u-EPX may be a useful non-invasive marker for asthma prediction in adolescence.
喘息在儿童早期很常见，但大多数儿童到学龄期时喘息症状会消失。然而，预测儿童期喘息的病程很困难。
研究3岁儿童尿嗜酸性粒细胞过氧化物酶（EPX，一种嗜酸性粒细胞活化标志物）是否有助于预测喘息持续情况及未来哮喘的诊断。
采用放射免疫分析法对基于人群的出生队列中的906名参与者在3岁时测量尿EPX。儿童随访至16岁。我们使用受试者工作特征（ROC）曲线研究尿EPX及其他因素在预测16岁时哮喘诊断方面的判别能力。
在613名有16岁随访信息的儿童中，511名有3岁时尿EPX数据及16岁时哮喘诊断数据；其中133名（21.7%）患有哮喘。根据纵向数据，将儿童分为喘息组：无喘息（NWZ）、早期短暂性（ETW）、迟发性（LOW）、间歇性（INT）和持续性喘息（PEW）。不同喘息组之间尿EPX水平差异显著（p = 0.003），症状持续的组尿EPX水平更高。在整个队列中，预测16岁时哮喘诊断的最佳分类模型包括性别、尿EPX、致敏和喘息（曲线下面积（AUC）= 0.82，95%置信区间：0.76 - 0.88）。单独的尿EPX和过敏致敏具有相似的预测能力（AUC [95%置信区间]：0.64 [0.58 - 0.71] 和0.65 [0.60 - 0.71]）。在3岁前有医生确诊喘息的儿童中，预测哮喘的最佳分类模型包括儿童3岁时的尿EPX和致敏、性别、胎龄及母亲特应性（AUC：0.76，95%置信区间：0.67 - 0.85）。
儿童早期尿EPX可能是预测青少年哮喘的一种有用的非侵入性标志物。
