口服避孕药、体质指数和哮喘：北欧—波罗的海人群的横断面研究
2009/03/27
背景：新出现的证据表明性类固醇激素可能影响气道阻塞，并且代谢状态会影响这些可能的作用。
目的：本研究调查了北欧—波罗的海以人群为基础的研究中服用口服避孕药（OCPs）和哮喘之间的关系，同时考虑与体重指数（BMI）可能的相互影响。
方法：1999～2001年间通过邮局向丹麦、爱沙尼亚、冰岛、挪威和瑞典的研究对象发放调查表（女性研究对象的应答率为77%）。孕妇、接受激素替代疗法的女性和年龄大于45岁的女性被排除。分析包括5791名25～44岁的女性，其中961名（17%）女性服用口服避孕药。Logistic回归分析校正了吸烟、月经不规律、BMI、年龄、居住条件和中心这些因素。
结果：口服避孕药与哮喘风险增加相关（比值比，1.42；95% CI，1.09-1.86），与合并花粉症的哮喘相关（比值比，1.48；95% CI，1.08-2.03），与喘息和呼吸短促症状相关（比值比，1.27；95% CI，1.02-1.60），与花粉症相关（比值比，1.25；95% CI，1.06-1.48），与3种以上的哮喘症状相关（比值比，1.29；95% CI，1.05-1.58）。不同中心的研究结果一致。这些相关性仅见于正常体重的女性（BMI 20-25 kg/m2, 哮喘: 1.45; 1.02-2.05）和超重的女性（BMI >25kg/m2: 1.91; 1.20-3.02），瘦削的女性（BMI <20 kg/m2: 0.41; 0.12-1.40）中这些相关性不存在。BMI与OCP间的交互作用与哮喘的关联十分明显（P交互作用 < 0.05）。
结论：服用口服避孕药的女性中哮喘患者较多，这种情况仅见于正常体重和超重的女性，表明性激素和代谢状态间的相互作用影响气道。这些结果来自通过邮局进行的横断面调查，应该谨慎解释这些结果。我们建议口服避孕药的临床试验中应当包括各种哮喘症状。
（张永明 审校）
Macsali F, et al. J Allergy Clin Immunol. 2009 Jan 2.
Macsali F, et al. J Allergy Clin Immunol. 2009 Jan 2. [Epub ahead of print]
Oral contraception, body mass index, and asthma: A cross-sectional Nordic-Baltic population survey.
BACKGROUND: Emerging evidence suggests that sex steroid hormones may influence airways obstruction, and that metabolic status may modify potential effects. OBJECTIVE: This study investigated the association between use of oral contraceptive pills (OCPs) and asthma in a Nordic-Baltic population-based study, while taking into account possible interplay with body mass index (BMI).
METHODS: Postal questionnaires were sent to subjects in Denmark, Estonia, Iceland, Norway, and Sweden from 1999 to 2001 (response rate in women, 77%). Pregnant women, women using hormone replacement therapy, and women >45 years were excluded. Analyses included 5791 women 25 to 44 years old, of whom 961 (17%) used OCP. Logistic regression analyses included adjustment for smoking, irregular menstruation, BMI, age, type of dwelling, and center.
RESULTS: Oral contraceptive pills were associated with increased risk for asthma (odds ratio, 1.42; 95% CI, 1.09-1.86), asthma with hay fever (1.48; 1.08-2.03), wheeze with shortness of breath (1.27; 1.02-1.60), hay fever (1.25; 1.06-1.48), and >/=3 asthma symptoms (1.29; 1.05-1.58). The findings were consistent between centers. The associations were present only among normal weight women (BMI 20-25 kg/m(2), asthma: 1.45; 1.02-2.05) and overweight women (BMI >25kg/m(2): 1.91; 1.20-3.02), but not among lean women (BMI <20 kg/m(2): 0.41; 0.12-1.40). Interaction between BMI and OCP in association with asthma was significant (P(interaction) < .05).
CONCLUSIONS: Women using oral contraceptive pills had more asthma. This was found only in normal weight and overweight women, indicating interplay between sex hormones and metabolic status in effect on the airways. The findings originate from a cross-sectional postal survey and should be interpreted with caution; it is recommended that asthma symptoms are included in clinical trials of oral contraception.
目的：本研究调查了北欧—波罗的海以人群为基础的研究中服用口服避孕药（OCPs）和哮喘之间的关系，同时考虑与体重指数（BMI）可能的相互影响。
方法：1999～2001年间通过邮局向丹麦、爱沙尼亚、冰岛、挪威和瑞典的研究对象发放调查表（女性研究对象的应答率为77%）。孕妇、接受激素替代疗法的女性和年龄大于45岁的女性被排除。分析包括5791名25～44岁的女性，其中961名（17%）女性服用口服避孕药。Logistic回归分析校正了吸烟、月经不规律、BMI、年龄、居住条件和中心这些因素。
结果：口服避孕药与哮喘风险增加相关（比值比，1.42；95% CI，1.09-1.86），与合并花粉症的哮喘相关（比值比，1.48；95% CI，1.08-2.03），与喘息和呼吸短促症状相关（比值比，1.27；95% CI，1.02-1.60），与花粉症相关（比值比，1.25；95% CI，1.06-1.48），与3种以上的哮喘症状相关（比值比，1.29；95% CI，1.05-1.58）。不同中心的研究结果一致。这些相关性仅见于正常体重的女性（BMI 20-25 kg/m2, 哮喘: 1.45; 1.02-2.05）和超重的女性（BMI >25kg/m2: 1.91; 1.20-3.02），瘦削的女性（BMI <20 kg/m2: 0.41; 0.12-1.40）中这些相关性不存在。BMI与OCP间的交互作用与哮喘的关联十分明显（P交互作用 < 0.05）。
结论：服用口服避孕药的女性中哮喘患者较多，这种情况仅见于正常体重和超重的女性，表明性激素和代谢状态间的相互作用影响气道。这些结果来自通过邮局进行的横断面调查，应该谨慎解释这些结果。我们建议口服避孕药的临床试验中应当包括各种哮喘症状。
（张永明 审校）
Macsali F, et al. J Allergy Clin Immunol. 2009 Jan 2.
Macsali F, et al. J Allergy Clin Immunol. 2009 Jan 2. [Epub ahead of print]
Oral contraception, body mass index, and asthma: A cross-sectional Nordic-Baltic population survey.
BACKGROUND: Emerging evidence suggests that sex steroid hormones may influence airways obstruction, and that metabolic status may modify potential effects. OBJECTIVE: This study investigated the association between use of oral contraceptive pills (OCPs) and asthma in a Nordic-Baltic population-based study, while taking into account possible interplay with body mass index (BMI).
METHODS: Postal questionnaires were sent to subjects in Denmark, Estonia, Iceland, Norway, and Sweden from 1999 to 2001 (response rate in women, 77%). Pregnant women, women using hormone replacement therapy, and women >45 years were excluded. Analyses included 5791 women 25 to 44 years old, of whom 961 (17%) used OCP. Logistic regression analyses included adjustment for smoking, irregular menstruation, BMI, age, type of dwelling, and center.
RESULTS: Oral contraceptive pills were associated with increased risk for asthma (odds ratio, 1.42; 95% CI, 1.09-1.86), asthma with hay fever (1.48; 1.08-2.03), wheeze with shortness of breath (1.27; 1.02-1.60), hay fever (1.25; 1.06-1.48), and >/=3 asthma symptoms (1.29; 1.05-1.58). The findings were consistent between centers. The associations were present only among normal weight women (BMI 20-25 kg/m(2), asthma: 1.45; 1.02-2.05) and overweight women (BMI >25kg/m(2): 1.91; 1.20-3.02), but not among lean women (BMI <20 kg/m(2): 0.41; 0.12-1.40). Interaction between BMI and OCP in association with asthma was significant (P(interaction) < .05).
CONCLUSIONS: Women using oral contraceptive pills had more asthma. This was found only in normal weight and overweight women, indicating interplay between sex hormones and metabolic status in effect on the airways. The findings originate from a cross-sectional postal survey and should be interpreted with caution; it is recommended that asthma symptoms are included in clinical trials of oral contraception.
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吸入突发事件和呼吸健康：欧洲共同体呼吸健康调查的结果
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