Phenotypic analysis of atopic dermatitis in children aged 1-12 months: elaboration of novel diagnostic criteria for infants in China and estimation of prevalence
Phenotypic analysis of atopic dermatitis in children aged 1-12 months: elaboration of novel diagnostic criteria for infants in China and estimation of prevalence
复制标题
1-12月龄儿童特应性皮炎的表型分析：中国婴儿新诊断标准的制定和患病率估计
DOI：
10.1111/jdv.15618
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发表时间：
2019-08-01
影响因子：
9.2
通讯作者：
Yao, Z.
中科院分区：
文献类型：
--
作者：
Guo, Y.;Zhang, H.;Yao, Z.
背景：特应性皮炎（AD）是婴幼儿最常见的皮肤病。然而，婴儿AD的诊断和明确意义仍然是一个有争议的问题。目的分析婴儿期阿尔茨海默病的表型，建立诊断标准并估计其在中国的患病率。方法采用多中心研究方法，在中国不同的大都市选取12个地点。经过仔细完整的病史和皮肤检查，明确诊断AD，并由当地经验丰富的皮肤科医生根据SCORAD指数确定AD的严重程度。在详细表型分析的基础上，选择婴儿AD的主要和具有代表性的临床特征，建立诊断标准并评价其诊断效果。结果本研究共纳入5967名婴儿。总体AD点患病率为30.48%。婴儿AD早在出生后第2个月发病，在出生后第3个月发病率最高，为40.81%。轻度、中度和重度AD的比例分别为67.40%、30.57%和2.03%。婴儿AD最常见的表现为面部皮炎（72.07%）、干燥（42.72%）和头皮皮炎（27.93%）。我们建立了新的婴儿诊断标准，包括：(1)出生2周后发病；（ii）与病变相当的瘙痒和/或烦躁和失眠；以及（iii）以上两项，加上以下其中一项，即可诊断为阿尔茨海默病：(i)分布于脸颊和/或头皮和/或伸展肢体的湿疹病变，以及（ii）身体任何其他部位的湿疹病变伴有干燥。结论根据皮肤科医生的临床诊断，中国婴幼儿AD患病率为30.48%。新的中国婴儿AD诊断标准显示出更高的敏感性和可比较的特异性。
Background Atopic dermatitis (AD) is the most common skin disorder in infancy. However, the diagnosis and definite significance of infantile AD remains a debated issue. Objective To analyse the phenotypes of AD in infancy, to establish diagnostic criteria and to estimate the prevalence of this condition in China. Methods This is a multicentric study, in which 12 locations were chosen from different metropolitan areas of China. Following careful and complete history-taking and skin examination, the definite diagnosis of AD was made and the severity based on the SCORAD index was determined by local experienced dermatologists. Based on the detailed phenotyping, the major and representative clinical features of infantile AD were selected to establish the diagnostic criteria and evaluate their diagnostic efficacy. Results A total of 5967 infants were included in this study. The overall point prevalence of AD was 30.48%. The infantile AD developed as early as at the second month of life, and its incidence peaked in the third month of life at 40.81%. The proportion of mild, moderate and severe AD was 67.40%, 30.57% and 2.03%, respectively. The most commonly seen manifestations in the infantile AD were facial dermatitis (72.07%), xerosis (42.72%) and scalp dermatitis (27.93%). We established the novel diagnostic criteria of infants, which included: (i) onset after 2 weeks of birth; (ii) pruritus and/or irritability and sleeplessness comparable with lesions; and (iii) all two items above with one of the following items can reach a diagnosis of AD: (i) eczematous lesions distributed on cheeks and/or scalp and/or extensor limbs, and (ii) eczematous lesions on any other parts of body accompanied by xerosis. Conclusions In China, the prevalence of AD in infancy is 30.48% according to clinical diagnosis of dermatologists. The novel Chinese diagnostic criteria for AD in infants show a higher sensitivity and comparable specificity.