哮喘联盟

   摘要
   研究背景：早年动物接触情况与儿童哮喘间的关系并不明确，且之前的研究结果存在争议。
   研究目的：本研究旨在评估接触狗和农场动物是否是哮喘发生的风险因子。
   试验设计、设置和受试者：本研究是一项全国性的队列研究，我们评估了早期接触狗和农场动物与哮喘风险间的相关性，2001年1月1日---2010年12月31日在瑞典出生的所有儿童均纳入研究（N = 1 011 051），我们收集了狗和农场的注册数据、哮喘药物治疗情况、诊断和父母及他们孩子的混杂因素。我们对6岁时诊断为哮喘的学龄儿童的比值比 (OR) 和1-5岁学龄前儿童哮喘发病率的风险比(HR) 之间的相关性进行了评估。从2007年1月1日到2012年9月30日进行数据分析。
   暴露因素：与狗或农场动物生活。
   主要结果和标准：儿童哮喘诊断和药物使用情况。
   研究结果：在研究期间出生的1011051例儿童中，376 638例学龄前儿童(53 460 [14.2%] 例与狗接触，1729 [0.5%]例与农村动物接触) 和276 298名学龄儿童 (22 629 [8.2%] 例与狗接触， 958 [0.3%] 例与农村动物接触)纳入分析。我们对这些儿童进行了随访，学龄前儿童队列中有18799例（5%）存在基线前哮喘事件，28511例哮喘事件，906071例存在风险。在学龄儿童队列，11585例儿童(4.2%)在7岁前经历过哮喘事件。第一年狗接触与学龄儿童(比值比, 0.87; 95%可信区间, 0.81-0.93) 和3岁或更大的学龄前儿童 (风险比, 0.90; 95% 可信区间, 0.83-0.99)哮喘发生风险降低相关，但与3岁以下的儿童哮喘发生风险不相关(风险比, 1.03; 95%可信区间, 1.00-1.07)。当只分析第一个出生的孩子时结果是相似的。农场动物接触与学龄儿童（比值比, 0.48; 95% 可信区间, 0.31-0.76）和学龄前儿童（风险比, 0.69; 95% 可信区间, 0.56-0.84）哮喘发生率下降有关。
   研究结论和意义：在本研究中，数据支持儿童第一年时接触狗或农场动物能降低6岁时发生哮喘风险的假设。这些信息可能有助于家庭和内科医生作出合适的决定和早期动物接触时间。
 

（杨冬 审校）
JAMA Pediatr. 2015 Nov 2;169(11):e153219. doi: 10.1001/jamapediatrics.2015.3219. Epub 2015 Nov 2.


 

Early Exposure to Dogs and Farm Animals and the Risk of Childhood Asthma.
 

Fall T1, Lundholm C2, Örtqvist AK2, Fall K3, Fang F2, Hedhammar Å4, Kämpe O5, Ingelsson E1, Almqvist C6.
 

Abstract
IMPORTANCE:The association between early exposure to animals and childhood asthma is not clear, and previous studies have yielded contradictory results.
OBJECTIVE:To determine whether exposure to dogs and farm animals confers a risk of asthma.
DESIGN, SETTING AND PARTICIPANTS:In a nationwide cohort study, the association between early exposure to dogs and farm animals and the risk of asthma was evaluated and included all children born in Sweden from January 1, 2001, to December 31, 2010 (N = 1 011 051), using registry data on dog and farm registration, asthma medication, diagnosis, and confounders for parents and their children. The association was assessed as the odds ratio (OR) for a current diagnosis of asthma at age 6 years for school-aged children and as the hazard ratio (HR) for incident asthma at ages 1 to 5 years for preschool-aged children. Data were analyzed from January 1, 2007, to September 30, 2012.
EXPOSURES:Living with a dog or farm animal.
MAIN OUTCOMES AND MEASURES:Childhood asthma diagnosis and medication used.
RESULTS:Of the 1 011 051 children born during the study period, 376 638 preschool-aged (53 460 [14.2%] exposed to dogs and 1729 [0.5%] exposed to farm animals) and 276 298 school-aged children (22 629 [8.2%] exposed to dogs and 958 [0.3%] exposed to farm animals) were included in the analyses. Of these, 18 799 children (5.0%) in the preschool-aged children's cohort experienced an asthmatic event before baseline, and 28 511 cases of asthma and 906 071 years at risk were recorded during follow-up (incidence rate, 3.1 cases per 1000 years at risk). In the school-aged children's cohort, 11 585 children (4.2%) experienced an asthmatic event during the seventh year of life. Dog exposure during the first year of life was associated with a decreased risk of asthma in school-aged children (OR, 0.87; 95% CI, 0.81-0.93) and in preschool-aged children 3 years or older (HR, 0.90; 95% CI, 0.83-0.99) but not in children younger than 3 years (HR, 1.03; 95% CI, 1.00-1.07). Results were comparable when analyzing only first-born children. Farm animal exposure was associated with a reduced risk of asthma in both school-aged children and preschool-aged children (OR, 0.48; 95% CI, 0.31-0.76, and HR, 0.69; 95% CI, 0.56-0.84), respectively.
CONCLUSIONS AND RELEVANCE:In this study, the data support the hypothesis that exposure to dogs and farm animals during the first year of life reduces the risk of asthma in children at age 6 years. This information might be helpful in decision making for families and physicians on the appropriateness and timing of early animal exposure.
 

JAMA Pediatr. 2015 Nov 2;169(11):e153219. doi: 10.1001/jamapediatrics.2015.3219. Epub 2015 Nov 2.