早期暴露与环境因素和中国广东省农村以及城区儿童哮喘之间的联系
2016/04/27
摘要
背景：环境因素在哮喘中起着重要的作用，但是相关研究的结论并不一致。
目的：探索早期暴露、环境因素与中国东南地区农村和城区儿童哮喘之间的联系。
方法：对7164例来自广州城区的儿童和6087例来自从化农村的儿童进行问卷筛查。第二阶段，招募了854例儿童作为次级样本（419例来自于广州，435例来自于从化）进行病例对照研究，该研究详细的问卷中包括了家族史、早期环境暴露、饮食习惯以及组胺气道激发试验、皮肤点刺试验和血清抗体分析等检查。从76个广州家庭以及80个从化家庭得到的室内灰尘样本用以分析内毒素、房尘螨和蟑螂变应原的水平。
结果：在这个筛查研究中，从化(3.4%)儿童的医生诊断的哮喘发生率较广州(6.9%, p<0.001)的儿童低。这个病例对照研究发现农村儿童相较于城区儿童发生哮喘的比例更低(2.8% vs. 29.4%, p<0.001)。遗传性过敏症(比值比 1.91, 95% 置信区间 1.58-2.29)，双亲的遗传性过敏症(2.49, 1.55-4.01)，3岁之前的住院治疗(2.54, 1.37-4.70)，高乳制品消耗(1.68, 1.03-2.73),和粉尘螨1等级(1.71, 1.34-2.19)与哮喘呈正相关，而1岁之前居住在耕种农作物家庭(0.15, 0.08-0.32)和粉尘内毒素水平（0.69,0.50-0.95）与哮喘呈负相关。
结论：来自于农业背景的农村儿童哮喘风险降低。在华南地区，早期暴露于农作物耕种以及高内毒素水平环境可能可以保护儿童免患哮喘。
Associations of early life exposures and environmental factors with asthma among children in rural and urban areas of Guangdong, China.
Feng M1, Yang Z1, Pan L1, Lai X2, Xian M1, Huang X1, Chen Y3, Schröder PC4, Roponen M5, Schaub B4, Wong GW6, Li J7.
Abstract
BACKGROUND:Environmental factors may play important roles in asthma, but findings were inconsistent.
OBJECTIVE:To determine the associations between early life exposures, environmental factors and asthma in urban and rural children in southeast China.
METHODS:A screening questionnaire survey was performed in 7164 children from urban Guangzhou and 6087 from rural Conghua. In the second stage, subsamples of 854 children (419 from Guangzhou, 435 from Conghua) were recruited for a case-control study including detailed questionnaire enquiring family history, early life environmental exposures, dietary habits, and testings including histamine airway provocation, skin prick test, and serum antibody analysis. House dust samples from 76 Guangzhou and 80 Conghua families were obtained to analyze levels of endotoxin, house dust mite and cockroach allergens.
RESULTS:The prevalence of doctor-diagnosed-asthma was lower in children from Conghua (3.4%) than Guangzhou (6.9%, p<0.001) in the screening survey. A lower percentage of asthma was found in rural compared to urban subjects (2.8% vs. 29.4%, p<0.001) in case-control study. Atopy (odds ratio 1.91, 95% confidence interval 1.58-2.29), parental atopy (2.49, 1.55-4.01), hospitalization before age 3 (2.54, 1.37-4.70), high milk product consumption (1.68, 1.03-2.73) and dust Dermatophagoides farinae 1 level (1.71, 1.34-2.19) were positively, while living in a crop-farming family before age 1 (0.15, 0.08-0.32) and dust endotoxin level (0.69, 0.50-0.95) were negatively associated with asthma.
CONCLUSIONS:Rural children from an agricultural background showed a reduced risk of asthma. Exposure to crop farming at early life and high environmental endotoxin levels might protect the children from asthma in southern China.
Chest. 2016Jan18.pii:S0012-3692(16)00450-5.doi:10.1016/j.chest.2015.12.028.[Epub ahead of print]
背景：环境因素在哮喘中起着重要的作用，但是相关研究的结论并不一致。
目的：探索早期暴露、环境因素与中国东南地区农村和城区儿童哮喘之间的联系。
方法：对7164例来自广州城区的儿童和6087例来自从化农村的儿童进行问卷筛查。第二阶段，招募了854例儿童作为次级样本（419例来自于广州，435例来自于从化）进行病例对照研究，该研究详细的问卷中包括了家族史、早期环境暴露、饮食习惯以及组胺气道激发试验、皮肤点刺试验和血清抗体分析等检查。从76个广州家庭以及80个从化家庭得到的室内灰尘样本用以分析内毒素、房尘螨和蟑螂变应原的水平。
结果：在这个筛查研究中，从化(3.4%)儿童的医生诊断的哮喘发生率较广州(6.9%, p<0.001)的儿童低。这个病例对照研究发现农村儿童相较于城区儿童发生哮喘的比例更低(2.8% vs. 29.4%, p<0.001)。遗传性过敏症(比值比 1.91, 95% 置信区间 1.58-2.29)，双亲的遗传性过敏症(2.49, 1.55-4.01)，3岁之前的住院治疗(2.54, 1.37-4.70)，高乳制品消耗(1.68, 1.03-2.73),和粉尘螨1等级(1.71, 1.34-2.19)与哮喘呈正相关，而1岁之前居住在耕种农作物家庭(0.15, 0.08-0.32)和粉尘内毒素水平（0.69,0.50-0.95）与哮喘呈负相关。
结论：来自于农业背景的农村儿童哮喘风险降低。在华南地区，早期暴露于农作物耕种以及高内毒素水平环境可能可以保护儿童免患哮喘。
(苏欣 审校)
Chest. 2016Jan18.pii:S0012-3692(16)00450-5.doi:10.1016/j.chest.2015.12.028.[Epub ahead of print]
Chest. 2016Jan18.pii:S0012-3692(16)00450-5.doi:10.1016/j.chest.2015.12.028.[Epub ahead of print]
Associations of early life exposures and environmental factors with asthma among children in rural and urban areas of Guangdong, China.
Feng M1, Yang Z1, Pan L1, Lai X2, Xian M1, Huang X1, Chen Y3, Schröder PC4, Roponen M5, Schaub B4, Wong GW6, Li J7.
Abstract
BACKGROUND:Environmental factors may play important roles in asthma, but findings were inconsistent.
OBJECTIVE:To determine the associations between early life exposures, environmental factors and asthma in urban and rural children in southeast China.
METHODS:A screening questionnaire survey was performed in 7164 children from urban Guangzhou and 6087 from rural Conghua. In the second stage, subsamples of 854 children (419 from Guangzhou, 435 from Conghua) were recruited for a case-control study including detailed questionnaire enquiring family history, early life environmental exposures, dietary habits, and testings including histamine airway provocation, skin prick test, and serum antibody analysis. House dust samples from 76 Guangzhou and 80 Conghua families were obtained to analyze levels of endotoxin, house dust mite and cockroach allergens.
RESULTS:The prevalence of doctor-diagnosed-asthma was lower in children from Conghua (3.4%) than Guangzhou (6.9%, p<0.001) in the screening survey. A lower percentage of asthma was found in rural compared to urban subjects (2.8% vs. 29.4%, p<0.001) in case-control study. Atopy (odds ratio 1.91, 95% confidence interval 1.58-2.29), parental atopy (2.49, 1.55-4.01), hospitalization before age 3 (2.54, 1.37-4.70), high milk product consumption (1.68, 1.03-2.73) and dust Dermatophagoides farinae 1 level (1.71, 1.34-2.19) were positively, while living in a crop-farming family before age 1 (0.15, 0.08-0.32) and dust endotoxin level (0.69, 0.50-0.95) were negatively associated with asthma.
CONCLUSIONS:Rural children from an agricultural background showed a reduced risk of asthma. Exposure to crop farming at early life and high environmental endotoxin levels might protect the children from asthma in southern China.
Chest. 2016Jan18.pii:S0012-3692(16)00450-5.doi:10.1016/j.chest.2015.12.028.[Epub ahead of print]
