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摘要: 目的 探讨血清总IgE诊断儿童及青少年特应症的价值。方法 选取2005—2006年美国国家健康与营养调查(NHANES)中接受血清总IgE和血清特异性IgE检测及过敏问卷调查且资料完整的6~19岁参与者的相关数据，根据血清特异性IgE检测和问卷结果分为特应症组和非特应症组，鼻炎组和非鼻炎组，比较血清总IgE组间差异，及其与特应症发病风险的关系；通过受试者工作特征曲线(ROC)分析血清总IgE诊断特应症的价值。结果 ① 血清总IgE在非特应症组的几何均数为24.4 kU/L，特应症组为153.1 kU/L，差异有统计学意义(P < 0.01)。②血清总IgE每增加10倍特应症发病风险增加17.6倍[95%CI：14.1~22.3]，差异有统计学意义(P < 0.01)。③血清总IgE诊断特应症的价值，在总人群中ROC曲线下面积(AUC)为0.857，最佳临界值为54.3kU/L，敏感度为80.0%，特异度为76.4%；鼻炎组中，AUC为0.888，最佳临界值为54.6 kU/L，敏感度为86.7%，特异度为77.0%；非鼻炎组中，AUC为0.841，最佳临界值为59.0 kU/L，敏感度为74.8%，特异度为78.6%。④随着血清总IgE升高，诊断特异度增加，敏感度下降。结论 血清总IgE与儿童及青少年特应症有密切关联性，特应症人群血清总IgE高于非特应症人群，随着血清总IgE的升高特应症发病风险增加，血清总IgE对特应症有较高的诊断价值。Abstract: Objective To explore the value of total IgE in the diagnosis of atopy in children and adolescents.Methods This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey from 2005-2006 included measurement of total and specific IgE levels and allergy questions for 6-19 year old children and adolescents. According to the results of specific IgE, participants were divided into the atopic or non- atopic group. Based on questionnaire, participants were divided into the rhinitis or non-rhinitis group. To compare the difference of total IgE between groups. The relationship between total IgE and atopy was analyzed. The value of total IgE in the diagnosis of atopy was analyzed by ROC curve.Results ① The geometric mean total IgE level in the non-atopic subjects and the atopic subjects were 24.4 kU/L and 153.1 kU/L, respectively. The difference between the two groups was statistically significant(P < 0.01). ②In logistic regression analyses, we observed the adjusted odds ratio(OR) for atopy with a 10-fold increase in total IgE level was 17.6[95%CI: 14.1-22.3], statistically significant changes(P < 0.01). ③The area under the receiver operator characteristic curve(AUC) of total IgE for diagnosing atopy in the total population were 0.857. The specificity and sensitivity of total IgE at the optimal cutoff of 54.3 kU/L on the ROC curve for diagnosing atopy were76.4%, and 80.0%, respectively. At the optimal cutoff of 54.6 kU/L for diagnosing atopy in the population with rhinitis, AUC, specificity, and sensitivity were 0.888, 86.7% and 77.0%, respectively. At the optimal cutoff of 59.0 kU/L for diagnosing atopy in the population with non-rhinitis, AUC, specificity, and sensitivity were 0.841, 74.8% and 78.6%, respectively. ④The diagnostic specificity of atopy increased with total IgE, while the sensitivity decreased.Conclusion There was a close relationship between total IgE and atopy. Total IgE level can be used to discriminates children and adolescents with and without atopy.
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Key words:
- total IgE /
- atopy /
- child /
- adolescents
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表 1 一般资料
例数(%) 几何均数(95%CI)/(kU·L-1 ) 中位数(25%~75%)/(kU·L-1 ) P值 总数 2857(100.0) 65.6(62.0~69.4) 63.1(23.3~190.0) 年龄/岁 0.338 6~11 898(31.4) 64.1(58.0~70.8) 63.8(22.8~175.2) 12~15 950(33.3) 63.2(57.3~69.7) 58.8(22.3~194.8) 16~19 1009(35.3) 69.4(63.1~76.2) 64.4(24.5~202.0) 性别 < 0.01 男 1419(49.7) 78.2(72.2~84.8) 71.7(26.6~236.0) 女 1438(50.3) 55.1(51.0~59.5) 54.2(20.7~154.0) 种族 < 0.01 非西班牙裔白人 740(25.9) 44.7(40.1~49.8) 45.5(16.4~112.2) 非西班牙裔黑人 911(31.9) 90.3(82.0~99.5) 81.8(33.8~262.0) 墨西哥裔美国人 969(33.9) 63.6(57.8~70.0) 64.0(23.3~186.0) 其他种族 237(8.3) 72.2(59.7~87.4) 61.7(23.3~198.0) 家庭教育 0.968 ≤12年级 1536(56.1) 65.8(61.1~71.0) 63.2(23.6~184.0) >12年级 1202(43.9) 65.4(59.8~71.5) 62.7(22.4~202.8) 贫困收入比率 0.005 [0，1.3] 1112(40.6) 71.5(65.6~78.0) 68.2(27.0~194.2) [1.3，3.5] 1008(36.8) 65.7(59.7~72.2) 63.0(23.5~188.8) [3.5，5.0] 622(22.7) 55.8(49.1~63.5) 53.2(17.1~186.8) 血清可替宁/(ng·mL-1
)0.148 低(< 0.015) 508(18.0) 58.1(50.7~66.5) 60.1(19.4~169.8) 中(0.015~10.000) 2054(72.7) 67.0(62.7~71.6) 63.2(23.7~191.8) 高(≥ 10.000) 264(9.3) 72.8(60.8~87.0) 67.3(27.0~205.2) 肥胖 < 0.01 无 1756(61.7) 60.1(55.9~64.6) 58.0(21.0~173.0) 有 1089(38.3) 76.0(69.6~83.1) 72.2(28.6~227.0) 特应症 < 0.01 无 1320(46.2) 24.4(22.9~26.1) 24.8(11.3~52.3) 有 1537(53.8) 153.1(144.0~162.8) 147.0(64.0~346.0) 鼻炎 < 0.01 无 2127(74.4) 56.7(53.2~60.4) 54.1(21.4~154.0) 有 730(25.6) 100.4(89.4~112.8) 101.5(34.5~309.8) 
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表 2 tIgE和特应症的关系
未调整模型 调整模型 OR(95%CI) P值 OR(95%CI) P值 Log10(tIgE) 17.7(14.4，22.1) < 0.001 17.6(14.1，22.3) < 0.01 tIgE分组 Q1组 1.0 1.0 Q2组 4.6(3.6，6.1) < 0.01 5.0(3.7，6.6) < 0.01 Q3组 18.0(13.8，23.9) < 0.01 20.2(15.1，27.3) < 0.01 Q4组 68.1(49.0，96.0) < 0.01 67.1(47.4，96.7) < 0.01
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