中华皮肤科杂志 ›› 2025, Vol. 58 ›› Issue (10): 943-951.doi: 10.35541/cjd.20250205

• 论著·儿童皮肤病 • 上一篇    下一篇

[开放获取]    儿童中重度特应性皮炎高频次发作的影响因素分析：一项全国多中心横断面调查研究

田晶1    郭一峰2    罗晓燕3    梁源1    李萍4    陈谨萍5    路遥6    汤建萍7    梁云生8    高莹9    钱秋芳10    舒虹11    陈宏翔12    樊平申13    韩秀萍14    钱华15    李钦峰16    李明17    王胜春18    刘盈1，18    王华3    马琳1   

  1. 1国家儿童医学中心 首都医科大学附属北京儿童医院皮肤科，北京  100045；2上海交通大学医学院附属新华医院皮肤科，上海  200092；3重庆医科大学附属儿童医院皮肤科    国家儿童健康与疾病临床医学研究中心  儿童发育疾病研究教育部重点实验室，重庆 400014 ；4深圳市儿童医院皮肤科，深圳  518000；5广州市妇女儿童医疗中心皮肤科，广州  551000；6成都市妇女儿童中心医院皮肤科，成都  610031；7湖南省儿童医院皮肤科，长沙  410007；8南方医科大学皮肤病医院皮肤科，广州  510091；9首都儿科研究所附属儿童医院皮肤科，北京  100020；10上海市儿童医院  上海交通大学附属儿童医院皮肤科，上海  200040；11昆明市儿童医院皮肤科，昆明  650000；12华中科技大学同济医学院附属协和医院皮肤科，武汉  430022；13空军军医大学西京皮肤医院，西安  710032；14中国医科大学附属盛京医院皮肤科，沈阳  110004；15苏州大学附属儿童医院皮肤科，苏州  215003；16天津市儿童医院皮肤科，天津  300074；17复旦大学附属儿科医院皮肤科&国家儿童医学中心，上海  200032；18河南省儿童医院郑州儿童医院皮肤科，郑州 450018
  • 收稿日期:2025-04-15 修回日期:2025-08-07 发布日期:2025-09-30
  • 通讯作者: 马琳 E-mail:bch_maleen@aliyun.com
  • 基金资助:
    北京市医院管理中心“登峰”人才培养计划（DFL20241201）

Analysis of factors influencing frequent episodes in children with moderate-to-severe atopic dermatitis: a national multicenter cross-sectional study

Tian Jing¹, Guo Yifeng², Luo Xiaoyan³, Liang Yuan¹, Li Ping⁴, Chen Jinping⁵, Lu Yao⁶, Tang Jianping⁷, Liang Yunsheng⁸, Gao Ying⁹, Qian Qiufang¹⁰, Shu Hong¹¹, Chen Hongxiang¹², Fan Pingshen¹³, Han Xiuping¹⁴, Qian Hua¹⁵, Li Qinfeng¹⁶, Li Ming¹⁷, Wang Shengchun18, Liu Ying1,18, Wang Hua3, Ma Lin¹   

  1. ¹Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China; ²Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; ³Department of Dermatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; ⁴Department of Dermatology, Shenzhen Children′s Hospital, Shenzhen 518000, Guangdong, China; ⁵Department of Dermatology, Guangzhou Women and Children′s Medical Center, Guangzhou 551000, China; ⁶Department of Dermatology, Chengdu Women′s and Children′s Central Hospital, Chengdu 610031, China; ⁷Department of Dermatology, Hunan Provincial Children′s Hospital, Changsha 410007, China; ⁸Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangzhou 510091, China; ⁹Department of Dermatology, Children′s Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China; ¹⁰Department of Dermatology, Shanghai Children′s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China; ¹¹Department of Dermatology, Kunming Children′s Hospital, Kunming 650000, China; ¹²Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; ¹³Department of Dermatology, Xijing Hospital, Air Force Medical University, Xi′an 710032, China; ¹⁴Department of Dermatology, Shengjing Hospital of China Medical University, Shenyang 110004, China; ¹⁵Department of Dermatology, Children′s Hospital of Soochow University, Suzhou 215003, Jiangsu, China; ¹⁶Department of Dermatology, Tianjin Children′s Hospital, Tianjin 300074, China; ¹⁷Department of Dermatology, National Center for Children′s Health, Children′s Hospital of Fudan University, Shanghai 200032, China; 18Department of Dermatology, Henan Children's Hospital Zhengzhou Children's Hospital, Zhengzhou 450018, China
  • Received:2025-04-15 Revised:2025-08-07 Published:2025-09-30
  • Contact: Ma Lin E-mail:bch_maleen@aliyun.com
  • Supported by:
    Beijing Hospitals Authority's Ascent Plan（DFL20241201）

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摘要： 【摘要】 目的 探讨我国儿童中重度特应性皮炎（AD）高频次发作（1年内发作 ≥ 4次）的相关因素。方法 本研究为全国性多中心横断面调查，纳入了2023年6月12日至8月8日在我国12省市18家医疗机构皮肤科门诊诊断为中重度AD的18岁以下患者。就诊时由其监护人填写调查问卷，调查内容涉及人口学特征、AD临床特征、个人史、家族史、与中重度AD发作相关的诱因、对治疗的依从性和疾病认知情况等。统计分析采用t检验、单因素方差分析、秩和检验和卡方检验，多选题采用多重响应分析方法。结果 共纳入问卷回收合格的中重度AD患儿965例，包括男531例，女434例，678例（70.3%）AD患儿2 ~ < 12岁，837例（86.7%）来自城镇，发病年龄（2.47 ± 3.03）岁，既往1年AD发作中位频次为4次。发作 < 4次和 ≥ 4次的患儿分别439例（45.5%）和526例（54.5%）。与发作 < 4次组相比，发作 ≥ 4次组患儿发病年龄更低［（2.22 ± 2.98）岁比（2.76 ± 3.06）岁，P = 0.006］，患儿自身［82.9%（436/526）比69.7%（306/439），χ2 = 23.42，P < 0.001］和监护人［66.0%（347/526）比57.4%（252/439），χ2 = 7.46，P = 0.006］合并其他过敏性疾病的比例均更高，润肤剂每月用量［150（30，300） g比60（6，200） g］及每日使用频次更高，疾病认知更充分但恐惧用药的情况更严重（均P < 0.05）。患儿所在地区和人类发展指数水平均与发作频次相关（均P < 0.001），发作≥ 4次组华南地区患儿占比最高（191例，36.3%）。发作 ≥ 4次组患儿局部连续使用糖皮质激素时长高于发作 < 4次组（Z = -2.21，P = 0.027）。与AD发作相关的外部诱因包括炎热（50.36%，486/965）、热水洗烫（40.73%，393/965）、海鲜（23.52%，227/965）、尘螨（33.37%，322/965）。结论　我国儿童中重度AD患者中，与高频次发作相关的因素可能包括位于南方或经济较发达地区、发病年龄较早、合并个体/家族过敏性疾病史及用药恐惧。

关键词: 皮炎, 特应性, 高频次发作, 影响因素, 横断面研究, 多中心研究, 调查和问卷

Abstract: 【Abstract】 Objective To investigate factors influencing frequent episodes （≥ 4 episodes within 1 year） in children with moderate-to-severe atopic dermatitis （AD） in China. Methods A national multicenter cross-sectional study was conducted. Patients under the age of 18 years diagnosed with moderate-to-severe AD were enrolled at dermatology clinics in 18 medical institutions across 12 provinces and municipalities in China between June 12 and August 8, 2023. At the time of the visit, their guardians completed a structured questionnaire covering demographic characteristics, clinical features of AD, personal and family history, factors associated with frequent episodes of moderate-to-severe AD, compliance with treatment, and disease awareness. Statistical analyses included t tests, one-way analysis of variance, rank-sum tests, and chi-square tests, with multiple-response analysis applied for multiple-choice questions. Results A total of 965 valid questionnaires were collected, and 965 children with moderate-to-severe AD were included. Among them, there were 531 males and 434 females, 678 （70.3%） were aged 2 - < 12 years, 837 （86.7%） were from urban areas, the age at onset was 2.47 ± 3.03 years, and the median frequency of AD episodes in the past year was 4 times. These children were divided into 2 groups based on the median episode frequency: < 4-episode group （439 cases, 45.5%） and ≥ 4-episode group （526 cases, 54.5%）. Compared with the < 4-episode group, children in the ≥ 4-episode group showed younger ages at onset （2.22 ± 2.98 years vs. 2.76 ± 3.06 years, P = 0.006） and higher proportions of patients with comorbid allergic diseases in both the children themselves （82.9% ［436/526］ vs. 69.7% ［306/439］, χ2 = 23.42, P < 0.001） and their relatives （66.0% ［347/526］ vs. 57.4% ［252/439］, χ2 = 7.46, P = 0.006）. Children in the ≥ 4- episode group also had higher monthly usage of moisturizers （150 ［30, 300］ g vs. 60 ［6, 200］ g） and daily frequency of moisturizer use, greater disease awareness, but more severe fear of medication use （all P < 0.05）. The region and the human development index level were both significantly associated with the episode frequency （both P < 0.001）, with the highest proportion of children from South China in the ≥ 4- episode group （36.3%, 191/526）. Children in the ≥ 4-episode group also had a longer duration of topical glucocorticoid use than those in the < 4-episode group （Z = -2.21, P = 0.027）. External triggers associated with AD episodes mainly included heat exposure （50.36%, 486/965）, hot water bathing （40.73%, 393/965）, seafood （23.52%, 227/965）, and dust mites （33.37%, 322/965）. Conclusion In children with moderate-to-severe AD in China, factors influencing frequent episodes may include residence in southern or economically developed regions, earlier age at onset, having a personal or family history of allergic diseases, and fear of medication use.

Key words: Dermatitis, atopic, Frequent episodes, Influencing factors, Cross-sectional studies, Multicenter study, Surveys and questionnaires

引用本文

田晶 郭一峰 罗晓燕 梁源 李萍 陈谨萍 路遥 汤建萍 梁云生 高莹 刘盈 钱秋芳 舒虹 陈宏翔 樊平申 韩秀萍 钱华 李钦峰 李明 王华 马琳. [开放获取]    儿童中重度特应性皮炎高频次发作的影响因素分析：一项全国多中心横断面调查研究[J]. 中华皮肤科杂志, 2025,58(10):943-951. doi:10.35541/cjd.20250205

Tian Jing¹, Guo Yifeng², Luo Xiaoyan³, Liang Yuan¹, Li Ping⁴, Chen Jinping⁵, Lu Yao⁶, Tang Jianping⁷, Liang Yunsheng⁸, Gao Ying⁹, Qian Qiufang¹⁰, Shu Hong¹¹, Chen Hongxiang¹², Fan Pingshen¹³, Han Xiuping¹⁴, Qian Hua¹⁵, Li Qinfeng¹⁶, Li Ming¹⁷, Wang Shengchun, Liu Ying, Wang Hua, Ma Lin¹. Analysis of factors influencing frequent episodes in children with moderate-to-severe atopic dermatitis: a national multicenter cross-sectional study[J]. Chinese Journal of Dermatology, 2025, 58(10): 943-951.doi:10.35541/cjd.20250205