早期和晚期对乙酰氨基酚暴露对哮喘和过敏症的影响：出生队列研究
2010/12/31
摘要
背景：尽管报道称对乙酰氨基酚与哮喘呈正相关，但对两者相关性的本质尚不清楚。
目的：研究婴儿和儿童对乙酰氨基酚使用与5～6岁时过敏症和过敏性疾病之间的关系。
方法：在此项出生队列研究中，基督城内出生至15个月内有对乙酰氨基酚暴露的儿童(n=505)和基督城和惠灵顿内5～6岁的儿童(n=914)入选本研究。对于所有研究对象，在6岁时收集当前哮喘、主诉的喘息和过敏症（通过皮肤针刺试验检测）等信息。 Logistic 回归模型对潜在的混杂因素进行校正，这些因素包括胸部感染次数和抗生素使用情况。
结果：15个月之前对乙酰氨基酚暴露与6岁时过敏症相关（校正后OR：3.61, 95%CI：1.33-9.77）。5～6岁时对乙酰氨基酚暴露与主诉的喘息和当前哮喘相关，且呈剂量依赖性，但与过敏症无相关性。与使用乙酰氨基酚0～2次相比，对于喘息，乙酰氨基酚使用3-10次的校正后OR(95% CI)为1.83 (1.04-3.23)，乙酰氨基酚使用>10次的校正后OR(95% CI)为2.30 (1.28-4.16)；对于当前哮喘，乙酰氨基酚使用3-10次的校正后OR(95% CI)为1.63 (0.92-2.89)，乙酰氨基酚使用>10次的校正后OR(95% CI)为2.16 (1.19-3.92)；对于过敏症，乙酰氨基酚使用3-10次的校正后OR(95% CI)为0.96 (0.59-1.56)，乙酰氨基酚使用>10次的校正后OR(95% CI)为1.05 (0.62-1.77)，
结论和临床相关性：我们的结果显示，对乙酰氨基酚在过敏症的发生过程中以及在哮喘症状的维持过程中起到一定作用。在形成临床推荐之前，需要进行随机对照研究，以确定是否存在上述相关性。
（陈欣 审校）
Clin Exp Allergy. 2010 Sep 29. doi:10.1111/j.1365-2222.2010.03610.x. [Epub ahead of print]
The effects of early and late paracetamol exposure on asthma and atopy: a birth cohort.
Wickens K, Beasley R, Town I, Epton M, Pattemore P, Ingham T, Crane J; the New Zealand Asthma and Allergy Cohort Study Group.
Wellington Asthma Research Group, Department of Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand Medical Research Institute of New Zealand, Wellington, New Zealand University of Canterbury, Christchurch, New Zealand Department of Respiratory Medicine, Christchurch Hospital, Christchurch, New Zealand Department of Paediatrics, University of Otago, Christchurch, New Zealand.
Abstract
Background Despite reports of positive associations between paracetamol and asthma, the nature of these associations is unclear. Objective We aimed to investigate the associations between infant and childhood paracetamol use and atopy and allergic disease at 5-6 years. Methods In a birth cohort study, we collected reported paracetamol exposure between birth and 15 months in Christchurch (n=505) and between 5 and 6 years for all participants (Christchurch and Wellington) (n=914). Outcome data for reported current asthma, reported wheeze and atopy (measured using skin prick tests) were collected at 6 years for all participants. Logistic regression models were adjusted for potential confounders, including the number of chest infections and antibiotic use. Results Paracetamol exposure before the age of 15 months was associated with atopy at 6 years [adjusted odds ratio (OR)=3.61, 95% confidence interval (CI) 1.33-9.77]. Paracetamol exposure between 5 and 6 years showed dose-dependent associations with reported wheeze and current asthma but there was no association with atopy. Compared with use 0-2 times, the adjusted OR (95% CI) were wheeze 1.83 (1.04-3.23) for use 3-10 times, and 2.30 (1.28-4.16) for use >10 times: current asthma 1.63 (0.92-2.89) for use 3-10 times and 2.16 (1.19-3.92) for use >10 times: atopy 0.96 (0.59-1.56) for use 3-10 times, and 1.05 (0.62-1.77) for use >10 times. Conclusion and Clinical Relevance Our findings suggest that paracetamol has a role in the development of atopy, and the maintenance of asthma symptoms. Before recommendations for clinical practice can be made, randomized-controlled trials are needed to determine whether these associations are causal.
Clin Exp Allergy. 2010 Sep 29. doi: 10.1111/j.1365-2222.2010.03610.x. [Epub ahead of print]
背景：尽管报道称对乙酰氨基酚与哮喘呈正相关，但对两者相关性的本质尚不清楚。
目的：研究婴儿和儿童对乙酰氨基酚使用与5～6岁时过敏症和过敏性疾病之间的关系。
方法：在此项出生队列研究中，基督城内出生至15个月内有对乙酰氨基酚暴露的儿童(n=505)和基督城和惠灵顿内5～6岁的儿童(n=914)入选本研究。对于所有研究对象，在6岁时收集当前哮喘、主诉的喘息和过敏症（通过皮肤针刺试验检测）等信息。 Logistic 回归模型对潜在的混杂因素进行校正，这些因素包括胸部感染次数和抗生素使用情况。
结果：15个月之前对乙酰氨基酚暴露与6岁时过敏症相关（校正后OR：3.61, 95%CI：1.33-9.77）。5～6岁时对乙酰氨基酚暴露与主诉的喘息和当前哮喘相关，且呈剂量依赖性，但与过敏症无相关性。与使用乙酰氨基酚0～2次相比，对于喘息，乙酰氨基酚使用3-10次的校正后OR(95% CI)为1.83 (1.04-3.23)，乙酰氨基酚使用>10次的校正后OR(95% CI)为2.30 (1.28-4.16)；对于当前哮喘，乙酰氨基酚使用3-10次的校正后OR(95% CI)为1.63 (0.92-2.89)，乙酰氨基酚使用>10次的校正后OR(95% CI)为2.16 (1.19-3.92)；对于过敏症，乙酰氨基酚使用3-10次的校正后OR(95% CI)为0.96 (0.59-1.56)，乙酰氨基酚使用>10次的校正后OR(95% CI)为1.05 (0.62-1.77)，
结论和临床相关性：我们的结果显示，对乙酰氨基酚在过敏症的发生过程中以及在哮喘症状的维持过程中起到一定作用。在形成临床推荐之前，需要进行随机对照研究，以确定是否存在上述相关性。
（陈欣 审校）
Clin Exp Allergy. 2010 Sep 29. doi:10.1111/j.1365-2222.2010.03610.x. [Epub ahead of print]
The effects of early and late paracetamol exposure on asthma and atopy: a birth cohort.
Wickens K, Beasley R, Town I, Epton M, Pattemore P, Ingham T, Crane J; the New Zealand Asthma and Allergy Cohort Study Group.
Wellington Asthma Research Group, Department of Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand Medical Research Institute of New Zealand, Wellington, New Zealand University of Canterbury, Christchurch, New Zealand Department of Respiratory Medicine, Christchurch Hospital, Christchurch, New Zealand Department of Paediatrics, University of Otago, Christchurch, New Zealand.
Abstract
Background Despite reports of positive associations between paracetamol and asthma, the nature of these associations is unclear. Objective We aimed to investigate the associations between infant and childhood paracetamol use and atopy and allergic disease at 5-6 years. Methods In a birth cohort study, we collected reported paracetamol exposure between birth and 15 months in Christchurch (n=505) and between 5 and 6 years for all participants (Christchurch and Wellington) (n=914). Outcome data for reported current asthma, reported wheeze and atopy (measured using skin prick tests) were collected at 6 years for all participants. Logistic regression models were adjusted for potential confounders, including the number of chest infections and antibiotic use. Results Paracetamol exposure before the age of 15 months was associated with atopy at 6 years [adjusted odds ratio (OR)=3.61, 95% confidence interval (CI) 1.33-9.77]. Paracetamol exposure between 5 and 6 years showed dose-dependent associations with reported wheeze and current asthma but there was no association with atopy. Compared with use 0-2 times, the adjusted OR (95% CI) were wheeze 1.83 (1.04-3.23) for use 3-10 times, and 2.30 (1.28-4.16) for use >10 times: current asthma 1.63 (0.92-2.89) for use 3-10 times and 2.16 (1.19-3.92) for use >10 times: atopy 0.96 (0.59-1.56) for use 3-10 times, and 1.05 (0.62-1.77) for use >10 times. Conclusion and Clinical Relevance Our findings suggest that paracetamol has a role in the development of atopy, and the maintenance of asthma symptoms. Before recommendations for clinical practice can be made, randomized-controlled trials are needed to determine whether these associations are causal.
Clin Exp Allergy. 2010 Sep 29. doi: 10.1111/j.1365-2222.2010.03610.x. [Epub ahead of print]
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儿童中有症状性哮喘与神经行为性共患病的关系
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变应性致敏作用与鼻病毒，而不是其它病毒诱导的儿童喘息有关
