早期应用抗生素可增加儿童哮喘患病几率
2007/08/01
除外已知的哮喘发病高危因素,学龄前儿童的哮喘可能还特异性与周岁前接受抗生素治疗有关。对此，Anita L. Kozyrskyj等人进行了一项流行病学调查，来评价两者间是否存在一定相关性。研究者从加拿大马尼托巴省的卫生保健和药品处方数据库中纵向选择13116例1995年出生的周岁内使用过抗生素且7岁之内发生哮喘的患儿，用流行病学研究中的反向因果关系及选择性偏移作为主要的研究方法，进行队列研究。
结果发现哮喘与非呼吸道感染情况下使用抗生素之间存在一定相关性(校正后似然比OR值为1.86;95%可信区间,CI为1.02～3.37)。接受4次疗程以上抗生素治疗的患儿其哮喘发病率最高(校正后OR值1.46,95%CI为1.14～1.88),尤其在乡村患儿中最明显，这些患儿中, 滥用广谱头孢菌素的情况最多见。该研究说明小儿哮喘的发病与早期滥用抗生素有关,避免广谱头孢菌素的滥用可明显减少其发病率。
结果发现哮喘与非呼吸道感染情况下使用抗生素之间存在一定相关性(校正后似然比OR值为1.86;95%可信区间,CI为1.02～3.37)。接受4次疗程以上抗生素治疗的患儿其哮喘发病率最高(校正后OR值1.46,95%CI为1.14～1.88),尤其在乡村患儿中最明显，这些患儿中, 滥用广谱头孢菌素的情况最多见。该研究说明小儿哮喘的发病与早期滥用抗生素有关,避免广谱头孢菌素的滥用可明显减少其发病率。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘译）
(Chest. 2007; 131:1753-1759)
Increased Risk of Childhood Asthma From Antibiotic Use in Early Life*
Anita L. Kozyrskyj, PhD; Pierre Ernst, MD and Allan B. Becker, MD
Abstract 摘要
Background: To address the major methodological issues of reverse causation and selection bias in epidemiologic studies of antibiotic use in early life and the development of asthma, we undertook a cohort study of this association in a complete population of children.
Methods: Using the health-care and prescription databases of Manitoba, Canada, this longitudinal study assessed the association between antibiotic prescription use during the first year of life and asthma at age 7 years in a 1995 birth cohort of 13,116 children.
Results: Independent of well-known asthma risk factors, asthma was significantly more likely to develop in children who had received antibiotics in the first year of life at age 7 years. The association with asthma was observed for antibiotic use in non-respiratory tract infections (adjusted odds ratio [OR], 1.86; 95% confidence interval [CI], 1.02 to 3.37). The risk of asthma was highest in children receiving more than four courses of antibiotics (adjusted OR, 1.46; 95% CI, 1.14 to 1.88), especially among rural children, and in the absence of maternal asthma or a dog in the birth year. Broad-spectrum (BS) cephalosporin use was more common in these subpopulations of children.
Conclusions: Antibiotic use in early life was associated with the development of childhood asthma, a risk that may be reduced by avoiding the use of BS cephalosporins.
Key Words: antibacterial agents • asthma • child • infant
