兒童異位性皮膚炎之季節發作模式與相關氣候因子

Abstract

背景與研究目的： 異位性皮膚炎是一種兒童常見的慢性皮膚發炎疾病，受到環境因子影響極深，且其發作特性非常多元，雖然過去許多研究都顯示環境溫度、濕度等氣候因素與疾病發作相關，然而結果卻相當不一致，造成疾病預防及介入措施上的困難。每位異位性皮膚炎兒童的疾病特性有所不同，在過去的環境研究中，卻鮮少將病童的不同季節發作特性納入考量。本研究旨在探討異位性皮膚炎兒童的不同季節發作特性，及分析其相關的氣候因子，以針對不同病童採取更好的環境介入對策。 研究方法： 本研究於2016-17年間，從全國各縣市分別抽取一所國民小學及一所國民中學進行兒童過敏情形、居住環境及人口學問卷調查，並由鄰近空氣汙染測站資料進行環境因子暴露評估。針對異位性皮膚炎兒童之過去12個月疾病發作情形，進行加權移動平均及主成分分析，將病童歸納出不同季節發作類型，並以多類別羅吉斯回歸及廣義估計方程式檢驗氣候因子對於不同發作類型之效應。 研究結果： 本研究共調查全國11,585位兒童，其中17.6%兒童回報過去12個月有異位性皮膚炎發作情形，並可分類出四種季節發作模式：春季好發者、夏秋季好發者、冬季好發者以及多季節好發者。父母教育程度較高以及有過敏疾病史、家中有牆壁黴菌、蟑螂、或是漏水者皆為兒童現存有異位性皮膚炎症狀的重要因子。在校正可能的干擾因子後，環境溫度以及相對濕度對於異位性皮膚炎季節發作模式分類有顯著效應，春季好發者與潮溼的冬季特性相關；夏秋季好發者與炎熱的夏秋季特性相關；冬季好發者，則與乾燥的氣候特性相關。 結論: 本研究發現現存異位性皮膚炎症狀之兒童有不同的季節發作模式，且根據其季節發作模式，相關的氣候特性也不相同，暗示著每個異位性皮膚炎兒童，可能對於不同的環境暴露有相異的易感受性，可作為未來發作預防及環境介入措施之重要參考。

BACKGROUND AND AIM: Atopic dermatitis (AD) is a prevalent childhood condition involving many people. The attack pattern has been quite diverse. Few studies have classified AD children into subgroups according to seasonal attack pattern. This study explores the methods to group AD children into seasonal attack patterns, and examines hereditary and climate factors on each subgroup in children with AD. METHODS: In Taiwanese children from one elementary and one middle schools in each of the cities/counties, allergic status, hereditary and living environmental factors were surveyed in 2016, as well as air pollutants by air monitoring stations. Among those with current AD, principal component analyses on weighted moving average of monthly attack score was applied to categorize AD attack subtypes. Multinomial logistic regression (MLR) and Generalized Estimating Equation (GEE) models were used to study the effects of environmental exposure on each AD attack subgroups. RESULTS: A total of 11,585 children were surveyed, and 17.6% of children reportedly had AD attack in the past 1 year. Among them, four attack patterns were identified: spring, summer/fall, winter and perennial. Parental atopic diseases and higher education, moldy wall, cockroaches and water damage in residence are important factors for children with current AD. After adjusting potential confounders, the average temperature and relative humidity were statistically significant in the classification of AD subtypes. Among seasonal attack patterns, spring-attack AD was associated with wet winter climate feature; summer-fall-attack with hot summer climate feature; winter-attack with dry climate feature during whole year. CONCLUSIONS: Distinguished attack patterns are identified in children with current AD. Depending on individual attack subtypes, climatic factors can be different, which suggest that each child with AD has different susceptibility to various climate features