哮喘联盟

   摘要
   背景：关于产后暴露于抗生素与发生哮喘具有相关性的证据较多，但关于产前暴露却不一致,甚至是知之甚少。
   目的：本研究为基于登记人群的巢式病例对照研究，旨在探索产前与产后暴露于不同种类的抗生素和儿童哮喘风险的关系。
   方法：通过国家卫生机构筛选出芬兰所有在1996-2004年出生，截止到2006年诊断为哮喘的儿童。对于每个病例，选择一个相匹配的对照组。关于哮喘诊断、购买抗哮喘药物和抗生素以及假定的混杂因素的信息由国家卫生机构获得。对3岁及以后诊断为哮喘的儿童两者关系采用条件logistic回归分析(n = 6 690 病例对照组)。
   结果：母亲在孕期使用抗生素与其后代哮喘风险增加具有相关性[校正后OR=1.31（95% CI 1.30–1.64）]。母亲使用的几种特别的抗生素与哮喘风险相关，最明显的关联是头孢菌素类[OR = 1.46 (95% CI 1.30–1.64)]。儿童在1岁内使用抗生素与哮喘风险增高具有相关性[OR = 1.60 (95% CI 1.48–1.73)]。儿童使用头孢菌素类[OR = 1.79 (95% CI 1.59–2.01)]，磺胺类和甲氧苄啶类[OR = 1.65 (95% CI 1.34–2.02)]，大环内酯类[OR = 1.61 (95% CI 1.46–1.78)]，以及阿莫西林[OR = 1.46 (95% CI 1.35–1.58)]与哮喘风险增高具有相关性。
   结论与临床相关性：产前与产后暴露于抗生素均与哮喘风险增加相关。抗生素对肠道菌群的潜在副作用与哮喘的发展应该进一步探究。
   关键词：抗生素，哮喘，儿童，流行病学，产前，登记处
 

(刘闪闪 张红萍 王刚  四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Clinical & Experimental Allergy; 2015; 45;137–145）


 

Prenatal and post-natal exposure to antibiotics and risk of asthma in childhood
 

J. Metsala, A. Lundqvist, L. J. Virta, M. Kaila, M. Gissler and S. M. Virtanen
 

Clinical & Experimental Allergy; 2015; 45;137–145
 

ABSTRACT
BACKGROUND: Evidence on the association between post-natal exposure to antibiotics and the development of asthma is extensive, but inconsistent and even less is known about prenatal exposure.
OBJECTIVE: The aim of this study was to examine the associations between prenatal and post-natal exposure to different antibiotics and the risk of childhood asthma in a population- and register-based nested case–control study.
METHODS: All children who were born in 1996–2004 in Finland and diagnosed with asthma by 2006 were identified from a national health register. For each case, one matched control was selected. Information on asthma diagnoses, purchased anti-asthmatic drugs and antibiotics as well as putative confounders was obtained from national health registries. The associations were analysed using conditional logistic regression for children diagnosed at the age of 3 years or later (n = 6 690 case–control pairs).
RESULTS: Maternal use of any antibiotics during pregnancy was associated with an
increased risk of asthma in the offspring [adjusted odds ratio (OR) = 1.31 (95% confidence interval (CI): 1.21–1.42)]. Several maternal specific antibiotics were associated with the risk of asthma, and the strongest association was observed for cephalosporins [OR = 1.46 (95% CI 1.30–1.64)]. Child’s use of antibiotics during the first year of life was associated with an increased risk of asthma [OR = 1.60 (95% CI 1.48–1.73)]. Child’s use of cephalosporins [OR = 1.79 (95% CI 1.59–2.01)], sulphonamides and trimethoprim [OR = 1.65 (95% CI 1.34–2.02)], macrolides [OR = 1.61 (95% CI 1.46–1.78)] and amoxicillin [OR = 1.46 (95% CI 1.35–1.58)] was associated with an increased risk of asthma.
CONCLUSIONS AND CLINICAL RELEVANCE: Both prenatal and post-natal exposure to antibiotics was associated with an increased risk of asthma. The potential role of adverse effects of antibiotics on the gut microbiota and the development of asthma should be further explored.
KEYWORDS: antibiotics, asthma, child, epidemiology, prenatal, registries