-
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.
-
Key words:
- total IgE /
- atopy /
- child /
- adolescents
-
-
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) 
下载: 导出CSV
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
下载: 导出CSV
-
[1] 中国医师协会儿科医师分会儿童耳鼻咽喉专业委员会. 儿童变应性鼻炎诊疗——临床实践指南[J]. 中国实用儿科杂志, 2019, 34(3): 169-175.
[2] Hoppin J A, Jaramillo R, Salo P, et al. Questionnaire predictors of atopy in a US population sample: findings from the National Health and Nutrition Examination Survey, 2005-2006[J]. Am J Epidemiology, 2011, 173(5): 544-552. doi: 10.1093/aje/kwq392
[3] Ezeamuzie CI, Al-ali SF, Al-dowaisan A, et al. Reference values of total serum IgE and their significance in the diagnosis of allergy among the young adult Kuwaiti population[J]. Clin Exp Allergy, 1999, 29(3): 375-381. doi: 10.1046/j.1365-2222.1999.00463.x
[4] Simoni M, Biavati P, Baldacci S, et al. The Po River Delta epidemiological survey: reference values of total serum IgE levels in a normal population sample of North Italy(8-78 yrs)[J]. Eur J Epidemiol, 2001, 17(3): 231-239. doi: 10.1023/A:1017929831911
[5] Kerkhof M, Dubois AE, Postma DS, et al. Role and interpretation of total serum IgE measurements in the diagnosis of allergic airway disease in adults[J]. Allergy, 2003, 58(9): 905-911. doi: 10.1034/j.1398-9995.2003.00230.x
[6] Sharma S, Kathuria PC, Gupta CK, et al. Total serum immunoglobulin E levels in a case-control study in asthmatic/allergic patients, their family members, and healthy subjects from India[J]. Clin Exp Allergy, 2006, 36(8): 1019-1027. doi: 10.1111/j.1365-2222.2006.02525.x
[7] Carosso A, Bugiani M, Migliore E, et al. Reference values of total serum IgE and their significance in the diagnosis of allergy in young European adults[J]. Int Arch Allergy Immunol, 2007, 142(3): 230-238. doi: 10.1159/000097025
[8] Gergen PJ, Arbes SJ Jr., Calatroni A, et al. Total IgE levels and asthma prevalence in the US population: results from the National Health and Nutrition Examination Survey 2005-2006[J]. J Allergy Clin Immunol, 2009, 124(3): 447-453. doi: 10.1016/j.jaci.2009.06.011
[9] Tu YL, Chang SW, Tsai HJ, et al. Total serum IgE in a population-based study of Asian children in Taiwan: reference value and significance in the diagnosis of allergy[J]. PLoS One, 2013, 8(11): e80996. doi: 10.1371/journal.pone.0080996
[10] Ahn JY, Choi BS. Clinical characteristics of total IgE in pediatric allergic disease[J]. Allergy Asthma Respir Dis, 2017, 5(4): 200-204. doi: 10.4168/aard.2017.5.4.200
[11] Kim HY, Choi J, Ahn K, et al. Reference Values and Utility of Serum Total Immunoglobulin E for Predicting Atopy and Allergic Diseases in Korean Schoolchildren[J]. J Korean Med Sci, 2017, 32(5): 803-809. doi: 10.3346/jkms.2017.32.5.803
[12] 余悠悠, 罗婷, 潘秀军. 血清过敏原特异性免疫球蛋白IgE检测在喘息患儿中的临床价值[J]. 中国实验诊断学, 2019, 23(12): 2077-2080. doi: 10.3969/j.issn.1007-4287.2019.12.010
[13] Sinclair D, Peters SA. The predictive value of total serum IgE for a positive allergen specific IgE result[J]. J Clin Pathol, 2004, 57(9): 956-959. doi: 10.1136/jcp.2004.017681
[14] Chung D, Park KT, Yarlagadda B, et al. The significance of serum total immunoglobulin E for in vitro diagnosis of allergic rhinitis[J]. Int Forum Allergy Rhinol, 2014, 4(1): 56-60. doi: 10.1002/alr.21240
[15] Al-Mughales JA. Diagnostic Utility of Total IgE in Foods, Inhalant, and Multiple Allergies in Saudi Arabia[J]. J Immunol Res, 2016, 2016: 1058632.
[16] Roxbury CR, Qiu M, Shargorodsky J, et al. Association Between Rhinitis and Depression in United States Adults[J]. J Allergy Clin Immunol Pract, 2019, 7(6): 2013-2020. doi: 10.1016/j.jaip.2019.02.034
[17] Racette SB, Yu L, Dupont NC, et al. BMI-for-age graphs with severe obesity percentile curves: tools for plotting cross-sectional and longitudinal youth BMI data[J]. BMC Pediatr, 2017, 17(1): 130. doi: 10.1186/s12887-017-0885-x
[18] Salo PM, Calatroni A, Gergen PJ, et al. Allergy-related outcomes in relation to serum IgE: results from the National Health and Nutrition Examination Survey 2005-2006[J]. J Allergy Clin Immunol, 2011, 127(5): 1226-1235.e7. doi: 10.1016/j.jaci.2010.12.1106
[19] Park SC, Kim JH, Lee KH, et al. Association of serum eosinophilia and total immunoglobulin E concentration with the risk of allergic symptoms and allergic sensitization, respectively: A 2-year follow-up study[J]. Int J Pediatr Otorhinolaryngol, 2016, 86: 167-171. doi: 10.1016/j.ijporl.2016.05.005
[20] Carlsson M, Thorell L, Sjölander A, et al. Variability of total and free IgE levels and IgE receptor expression in allergic subjects in and out of pollen season[J]. Scand J Immunol, 2015, 81(4): 240-248. doi: 10.1111/sji.12270
[21] Xu-De Z, Bei-Bei G, Xi-Juan W, et al. Serum IgE Predicts Difference of Population and Allergens in Allergic Diseases: Data from Weifang City, China[J]. Mediators Inflamm, 2021, 2021: 6627087.
-
图(3)
表(2)
计量
- 文章访问数: 1894
- PDF下载数: 1680
- 施引文献: 0