9个欧洲出生队列研究中分娩方式与学龄期儿童哮喘的关系
2017/07/24
摘要
分娩方式与学龄期儿童哮喘的关系还不明确。我们纳入了1996 ~2006年间的9个欧洲出生队列以评估特定的分娩方式与儿童期哮喘的关系。使用Poisson回归模型分别计算各5-9岁儿童哮喘队列、以及合并队列的原始风险比和调整风险比。在足月出生的儿童中进行敏感性分析以减少围产期相关混杂因素的影响。
本研究包含了67,613位参与者。各队列剖宫产率在9.4% 到37.5%之间不等。与经阴道分娩相比，剖宫产与哮喘风险的增加有关(调整风险比(aRR) = 1.22, 95%置信区间(CI): 1.02, 1.46)。相对于自然阴道分娩，择期剖宫产的哮喘调整风险比为1.33 (95% CI: 1.02, 1.75)，急诊剖宫产为1.07 (95% CI: 0.94,1.22)，手术阴道分娩的为0.97 (95% CI: 0.84, 1.12)。在足月出生的儿童中，以上相关性仅在择期剖宫产组中增加(aRR = 1.49, 95% CI: 1.13,1.97)。本研究基于较大的样本量分析特定的分娩方式与学龄期儿童哮喘的关系。择期剖宫产与儿童哮喘风险增加相关，尤其在足月儿，提示在没有明确医学指征时应减少采用这一手术。
Mode of Delivery and Asthma at School Age in 9 European Birth Cohorts.
Rusconi F, Zugna D, Annesi-Maesano I, et al.
Abstract
Evidence on the association between mode of delivery and asthma at school age is
inconclusive. We assessed the associations between specific modes of delivery and
asthma in children from 9 European birth cohorts that enrolled participants between 1996 and 2006. Cohort-specific crude and adjusted risk ratios for asthma at ages 5-9 years were calculated using Poisson regression models and pooled. A sensitivity analysis was carried out in children born at term to reduce confounding due to perinatal factors. The study included 67,613 participants. Cohort-specific rates of cesarean delivery varied from 9.4% to 37.5%. Cesarean delivery, as opposed to vaginal delivery, was associated with an increased risk of asthma (adjusted risk ratio (aRR) = 1.22, 95% confidence interval (CI): 1.02, 1.46). Compared with spontaneous vaginal delivery, the adjusted risk ratio was 1.33 (95% CI: 1.02, 1.75) for elective cesarean delivery, 1.07 (95% CI: 0.94,1.22) for emergency cesarean delivery, and 0.97 (95% CI: 0.84, 1.12) for operative vaginal delivery. In children born at term, the associations were strengthened only for elective cesarean delivery (aRR = 1.49, 95% CI: 1.13,1.97). The large sample size allowed analysis of the associations between specific modes of delivery and asthma at school age. The increased risk of asthma associated with elective cesarean delivery, especially among children born at term, is relevant in counteracting the increasing use of this procedure, which is often performed without a clear medical indication.
Am J Epidemiol. 2017 Mar 15;185(6):465-473. doi: 10.1093/aje/kwx021.
分娩方式与学龄期儿童哮喘的关系还不明确。我们纳入了1996 ~2006年间的9个欧洲出生队列以评估特定的分娩方式与儿童期哮喘的关系。使用Poisson回归模型分别计算各5-9岁儿童哮喘队列、以及合并队列的原始风险比和调整风险比。在足月出生的儿童中进行敏感性分析以减少围产期相关混杂因素的影响。
本研究包含了67,613位参与者。各队列剖宫产率在9.4% 到37.5%之间不等。与经阴道分娩相比，剖宫产与哮喘风险的增加有关(调整风险比(aRR) = 1.22, 95%置信区间(CI): 1.02, 1.46)。相对于自然阴道分娩，择期剖宫产的哮喘调整风险比为1.33 (95% CI: 1.02, 1.75)，急诊剖宫产为1.07 (95% CI: 0.94,1.22)，手术阴道分娩的为0.97 (95% CI: 0.84, 1.12)。在足月出生的儿童中，以上相关性仅在择期剖宫产组中增加(aRR = 1.49, 95% CI: 1.13,1.97)。本研究基于较大的样本量分析特定的分娩方式与学龄期儿童哮喘的关系。择期剖宫产与儿童哮喘风险增加相关，尤其在足月儿，提示在没有明确医学指征时应减少采用这一手术。
(复旦大学附属中山医院呼吸科 胡湘麟摘译 杨冬审校)
（Am J Epidemiol. 2017 Mar 15;185(6):465-473. doi: 10.1093/aje/kwx021.）
（Am J Epidemiol. 2017 Mar 15;185(6):465-473. doi: 10.1093/aje/kwx021.）
Mode of Delivery and Asthma at School Age in 9 European Birth Cohorts.
Rusconi F, Zugna D, Annesi-Maesano I, et al.
Abstract
Evidence on the association between mode of delivery and asthma at school age is
inconclusive. We assessed the associations between specific modes of delivery and
asthma in children from 9 European birth cohorts that enrolled participants between 1996 and 2006. Cohort-specific crude and adjusted risk ratios for asthma at ages 5-9 years were calculated using Poisson regression models and pooled. A sensitivity analysis was carried out in children born at term to reduce confounding due to perinatal factors. The study included 67,613 participants. Cohort-specific rates of cesarean delivery varied from 9.4% to 37.5%. Cesarean delivery, as opposed to vaginal delivery, was associated with an increased risk of asthma (adjusted risk ratio (aRR) = 1.22, 95% confidence interval (CI): 1.02, 1.46). Compared with spontaneous vaginal delivery, the adjusted risk ratio was 1.33 (95% CI: 1.02, 1.75) for elective cesarean delivery, 1.07 (95% CI: 0.94,1.22) for emergency cesarean delivery, and 0.97 (95% CI: 0.84, 1.12) for operative vaginal delivery. In children born at term, the associations were strengthened only for elective cesarean delivery (aRR = 1.49, 95% CI: 1.13,1.97). The large sample size allowed analysis of the associations between specific modes of delivery and asthma at school age. The increased risk of asthma associated with elective cesarean delivery, especially among children born at term, is relevant in counteracting the increasing use of this procedure, which is often performed without a clear medical indication.
Am J Epidemiol. 2017 Mar 15;185(6):465-473. doi: 10.1093/aje/kwx021.
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COPD患者急性加重的频率：对COPD亚人群中期结果分析（SPIROMICS）的队列研究
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真实世界中哮喘-COPD 重叠综合征（ACOS）的共病，表现及影响
