哮喘发病率与家族中成员人数及出生次序的关系
2007/08/01
有一种假说认为家族中的长者对年幼的人的免疫系统起一定的调节作用以减少其哮喘的发病。如果这种假说正确,那么哮喘发病率应与出生的次序成一定的反比关系。为验证哮喘患病率与家族中孩子个数和出生次序是否存在一定的相关性,Shmuel Goldberg调查了531,116名以军士兵的病历。对其家庭中子女数和哮喘患病率之间, 出生次序与哮喘患病率之间分别进行了相关性评估。分别用哮喘患病率比出生次序和家系的大小得出一似然比,校正后进行计算。
研究结果说明哮喘患病率与家庭中孩子个数有关(独生子女患病率为7.3%,3个子女的家庭中患病率增至8.95%,之后, 大于4个子女时则呈负相关, 随着兄弟姐妹人数的增加,患病率逐渐下降,并在有15～20个兄弟姐妹的义务兵家庭中降至最低0.58%.各子女的哮喘患病率之间无差别。)而患病率与出生次序无关(不同出生次序的患病率相似)。
该结果反驳了既往宣称的大家族中哮喘患病率降低的假说。
该结果反驳了既往宣称的大家族中哮喘患病率降低的假说。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘译）
(Chest. 2007; 131:1747-1752)
Asthma Prevalence, Family Size, and Birth Order*
Shmuel Goldberg, MD; Eran Israeli, MD ; Shepard Schwartz, MD; Tzippora Shochat, MSc; Gabriel Izbicki, MD; Ori Toker-Maimon, MD; Eyal Klement, DVM and Elie Picard, MD
Shmuel Goldberg, MD; Eran Israeli, MD ; Shepard Schwartz, MD; Tzippora Shochat, MSc; Gabriel Izbicki, MD; Ori Toker-Maimon, MD; Eyal Klement, DVM and Elie Picard, MD
Abstract 摘要
Background: Asthma prevalence may be reduced in large families. The hygiene hypothesis suggests that older siblings protect their younger siblings from asthma through a modulating effect on the still-maturing immune system. If the hygiene hypothesis is correct, asthma prevalence should be inversely related to birth order. The objective of this study was to examine the relationship between asthma prevalence, and family size and birth order.
Background: Asthma prevalence may be reduced in large families. The hygiene hypothesis suggests that older siblings protect their younger siblings from asthma through a modulating effect on the still-maturing immune system. If the hygiene hypothesis is correct, asthma prevalence should be inversely related to birth order. The objective of this study was to examine the relationship between asthma prevalence, and family size and birth order.
Methods: The medical records of 531,116 Israeli military conscripts were reviewed. The association between number of children in the family and the prevalence of asthma, and between birth order and the prevalence of asthma was assessed. Odds ratios for asthma by birth order and family size, adjusted for each other, were calculated.
Results: Asthma was diagnosed in 26,833 male subjects (8.6%) and 15,079 female subjects (6.9%). Asthma prevalence was inversely related to the number of children in the family (p < 0.001). Among subjects who were the only child in the family, the prevalence of asthma was 7.3%. The prevalence increased to 8.95% among subjects from families with three siblings, and then progressively decreased as the number of siblings increased, and reached a trough of 0.58% in conscripts from families of 15 to 20 siblings. Asthma prevalence was similar for all birth orders.
Conclusions: In families with four or more children, asthma prevalence is inversely related to the number of children in the family. Asthma prevalence is similar for all birth orders. The similar asthma prevalence for all birth orders challenges the hygiene hypothesis as the mechanism for the decreased asthma prevalence in large families.
Key Words: asthma . epidemiology . pediatrics
