哮喘联盟

    胎儿期，儿童时期及成年后应用对乙酰氨基酚会增加罹患哮喘的风险。作者研究了国际儿童哮喘与其它过敏性疾病研究（ISAAC）第III阶段中纳入的6～7岁儿童，了解应用对乙酰氨基酚与哮喘的关系。作为ISAAC III期研究的一部分，6～7岁儿童的父母或监护人填写调查问卷，内容涉及哮喘、结膜炎、皮疹症状，以及一些危险因素，包括儿童1岁内发烧时应用对乙酰氨基酚以及在过去12个月中应用对乙酰氨基酚的次数。
    主要观察指标为1岁内发烧时应用对乙酰氨基酚的儿童出现哮喘症状的比数比 (OR)。共纳入来自31个国家73个中心的205 487名6～7岁儿童。经多因素回归分析发现，1岁内发烧时应用对乙酰氨基酚与6～7岁时出现哮喘症状相关(OR 1.46 [95% CI 1.36-1.56])。近期应用对乙酰氨基酚则与出现哮喘症状的危险性存在着剂量相关性 (中等剂量、高剂量与未应用者的OR值分别为1.61 [1.46-1.77] ，3.23 [2.91-3.60])。应用对乙酰氨基酚与严重哮喘同样具有相关性，人群归因危险度为22%～38%。不管是在1岁内，还是在6～7岁时应用对乙酰氨基酚都会增加出现结膜炎症状或皮疹的危险性。应用对乙酰氨基酚可能是儿童哮喘发病的一个危险因素。

(马艳良 北京大学人民医院呼吸科 100044 摘译)
(Lancet. 2008 Sep 20;372(9643):1039-1048.)

Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from Phase Three of the ISAAC programme.

Beasley R, Clayton T, Crane J, von Mutius E, Lai CK, Montefort S, Stewart A; ISAAC Phase Three Study Group.Collaborators (96) 
Lancet. 2008 Sep 20;372(9643):1039-48.
BACKGROUND: Exposure to paracetamol during intrauterine life, childhood, and adult life may increase the risk of developing asthma. We studied 6-7-year-old children from Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) programme to investigate the association between paracetamol consumption and asthma. 
METHODS: As part of Phase Three of ISAAC, parents or guardians of children aged 6-7 years completed written questionnaires about symptoms of asthma, rhinoconjunctivitis, and eczema, and several risk factors, including the use of paracetamol for fever in the child’s first year of life and the frequency of paracetamol use in the past 12 months. The primary outcome variable was the odds ratio (OR) of asthma symptoms in these children associated with the use of paracetamol for fever in the first year of life, as calculated by logistic regression. 
FINDINGS: 205 487 children aged 6-7 years from 73 centres in 31 countries were included in the analysis. In the multivariate analyses, use of paracetamol for fever in the first year of life was associated with an increased risk of asthma symptoms when aged 6-7 years (OR 1.46 [95% CI 1.36-1.56]). Current use of paracetamol was associated with a dose-dependent increased risk of asthma symptoms (1.61 [1.46-1.77] and 3.23 [2.91-3.60] for medium and high use vs no use, respectively). Use of paracetamol was similarly associated with the risk of severe asthma symptoms, with population-attributable risks between 22% and 38%. Paracetamol use, both in the first year of life and in children aged 6-7 years, was also associated with an increased risk of symptoms of rhinoconjunctivitis and eczema. 
INTERPRETATION: Use of paracetamol in the first year of life and in later childhood, is associated with risk of asthma, rhinoconjunctivitis, and eczema at age 6 to 7 years. We suggest that exposure to paracetamol might be a risk factor for the development of asthma in childhood.