父母孕前BMI联合儿童出生体质量及BMI对哮喘发生的预测价值

The predictive value of parental BMI combined with child birth weight and BMI in childhood asthma

目的探讨父母孕前身体质量指数(BMI)、儿童出生体质量及BMI与儿童哮喘发生的潜在关联及预测价值。方法选取2019年9月至2023年1月在合肥市第二人民医院儿科就诊并符合纳入标准的患儿1760例,根据是否患有哮喘,分为哮喘组(n=440)和对照组(n=1320)。比较两组患儿一般临床资料,使用多因素logistic回归分析父亲BMI、母亲孕前BMI、母亲妊娠期体质量增加量、儿童出生体质量及儿童BMI与儿童哮喘发生的相关性;使用受试者工作特征(ROC)曲线分析危险因素对儿童哮喘发生的预测价值。结果两组患儿父亲BMI、母亲孕前BMI、妊娠期体质量增加量、儿童出生体质量、BMI、母亲患有哮喘的比例差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,父亲BMI(OR=1.610,95%CI:1.431~1.821)、母亲孕前BMI(OR=2.107,95%CI:1.839~2.424)、母亲妊娠期体质量增加量(OR=3.970,95%CI:3.325~4.801)、儿童出生体质量(OR=1.006,95%CI:1.006~1.007)及BMI(OR=1.427,95%CI:1.109~1.841)是儿童哮喘的危险因素(P<0.05)。ROC曲线分析显示,儿童出生体质量、母亲妊娠期体质量增加量、儿童BMI、母亲孕前BMI和父亲BMI 5项危险因素联合检测对哮喘发生预测的曲线下面积为0.960,分别大于单独检测(0.826、0.893、0.562、0.827、0.718)。联合评估的灵敏度为91.7%,特异度为91.5%,均高于单独检测(67.0%、85.7%、67.3%、78.4%、58.2%;84.5%、83.7%、44.2%、90.2%、77.1%)。结论父母孕前BMI、母亲妊娠期体质量增加量、儿童出生体质量及BMI与哮喘发生密切相关,联合诊断对哮喘发生有更高的预测价值。

Objective To investigate the potential association and predictive value between maternal BMI before pregnancy,maternal weight gain during pregnancy,birth weight,and childhood asthma.Methods A total of 1760 children were selected from pediatric outpatient department of Hefei Second People’s Hospital from September 2019 to January 2023,and divided into an asthma group(n=440)and a control group(n=1320)according to whether they had asthma.Case-control studies were carried out,and their general clinical data were compared,and multivariate logistic regression was used to analyze the correlation between BMI before pregnancy,maternal weight gain during pregnancy,birth weight,BMI and asthma in children.The ROC curve was used to assess its predictive value.Results There were significant differences in BMI,gestational weight gain,birth weight,BMI and the proportion of mothers with asthma between the two groups(P<0.05).Multivariate lo⁃gistic regression analysis showed that paternal BMI(OR=1.006,95%CI:1.006~1.007),maternal preconception BMI(OR=2.107,95%CI:1.839~2.424),gestational weight gain of mothers(OR=3.970,95%CI:3.325~4.801),birth weight(OR=1.006,95%CI:1.006~1.007)and BMI(OR=1.427,95%CI:1.109~1.841)of children were independent risk factors for childhood asthma(P<0.05).ROC curve analysis showed that the AUC of the five risk factors of child birth weight,maternal weight gain during pregnancy,child BMI,maternal pre-pregnancy BMI and paternal BMI for the prediction of asthma was 0.960,which was significantly higher than that of the single test(0.826,0.893,0.562,0.827 and 0.718),respectively.The sensitivity and specificity of the combined assessment was 91.7%and 91.5%respectively,which were higher than those of the individual test(67.0%,85.7%,67.3%,78.4%and 58.2%;84.5%,83.7%,44.2%,90.2%,77.1%)respectively.Conclusion Parental BMI before preg⁃nancy,maternal weight gain during pregnancy,birth weight,and BMI are related to childhood asthma,and combined diagnosis has a higher pre⁃dictive value for childhood asthma.