哮喘联盟

   摘要
   一些流行病学研究报告显示出生首年的抗生素用量和之后发生哮喘存在相关性, 但其结果是矛盾的并且存在潜在的偏倚。 我们以人群为基础进行出生队列研究探究这一有争议的问题。通过管理性数据, 我们选定了143,163名出生于1995-2011年间弗留利—威尼斯朱利亚 (意大利)的儿童(平均随访 5.25 年, 927,350人/年)。 通过药物处方记录检索这些儿童在出生首年的抗生素使用和后续的哮喘治疗 (哮喘治疗定义为在12个月内大于等于2次哮喘药物处方)。 我们采用Poisson回归模型分析，测定调整过的围产期变量和出生首年因感染住院的事件发生比值（IRR）。 共确诊34,957例新发哮喘病例。出生首年抗生素使用增加了新发哮喘的风险 [IRR 1.51, 95 % 置信区间(CI) 1.48-1.54]并且与抗生素使用剂量呈相关性 (p-trend <0.001). 抗生素的应用增加了患哮喘风险，这种风险在出生后13-35个月间最高 (IRR 2.07, 95 % CI 2.00-2.14)，但患哮喘风险在出生后36-71个月(IRR 1.17, 95 % CI 1.14-1.21) 和大于等于72个月仍显著存在 (IRR 1.15, 95 % CI 1.08-1.22)。抗生素增加了大于等于6岁(IRR 1.35, 95 % CI 1.30-1.41)和大于等于13 岁 (IRR 1.19, 95 % CI 1.08-1.33)儿童的目前哮喘风险。婴儿期抗生素暴露增加了儿童直到青春期的哮喘发生风险。在较大的年龄组发现这种关系不能用逆向因果关系解释； 然而，通过呼吸道感染而未入院者不能被排除。

（杨冬 审校）
Eur J Epidemiol. 2015 May 9. [Epub ahead of print]

 

Antibiotic exposure in the first year of life and later treated asthma, a population based birth cohort study of 143,000 children.
 

Pitter G1, Ludvigsson JF, Romor P, Zanier L, Zanotti R, Simonato L, Canova C.
Author information
 

Abstract
Several epidemiological studies reported an association between antibiotic consumption in the first year of life and later asthma, but results are conflicting and affected by potential biases. We examined this controversial issue in a population-based birth cohort. Using administrative data, we identified 143,163 children born in 1995-2011 in Friuli-Venezia Giulia (Italy) (median follow-up 5.25 years, 927,350 person-years). Antibiotic prescriptions in the first year of life and subsequent treated asthma (defined as ≥2 anti-asthmatic drug prescriptions within a 12-month period) were retrieved from drug prescription records. We estimated incidence rate ratios (IRR) using Poisson regression models, adjusted for perinatal variables and for hospitalizations for infections in the first year of life. We identified 34,957 new-onset asthma cases. Antibiotic consumption in the first year of life increased the risk of new-onset asthma [IRR 1.51, 95 % confidence interval (CI) 1.48-1.54] with a dose-response relationship (p-trend <0.001). The risk was highest for asthma identified at 13-35 months of life (IRR 2.07, 95 % CI 2.00-2.14), but remained statistically significant for asthma identified at 36-71 months (IRR 1.17, 95 % CI 1.14-1.21) and at ≥72 months (IRR 1.15, 95 % CI 1.08-1.22). Antibiotics increased the risk of current asthma at ≥6 years (IRR 1.35, 95 % CI 1.30-1.41) and at ≥13 years of age (IRR 1.19, 95 % CI 1.08-1.33). Antibiotic exposure in infancy is associated with an increased risk of asthma up to adolescence. The association detected at older ages is not explained by reverse causation; however, confounding by respiratory infections not leading to hospital admission cannot be excluded.
 

Eur J Epidemiol. 2015 May 9. [Epub ahead of print]