哮喘联盟

   摘要
   背景：曼彻斯特社区哮喘学会(MANCAS)发现儿童出生时进行BCG疫苗接种可预防6～11岁时发生喘息的风险。我们后来的系统回顾和meta分析提示BCG疫苗接种不能预防变异性致敏，但可能对非过敏性哮喘有预防作用。
   目的：MANCAS队列观察到BCG疫苗接种对喘息有预防作用，我们设法评估了此预防作用是否能保持到13～17岁，并把MANCAS最终分析的结果纳入到一个更新的系统回顾和meta分析中。
   方法：通过健康记录确定BCG疫苗接种状态，通过问卷反馈确定呼吸道结局。我们更新了系统回顾，并采用固定影响模型和随机影响模型来进行meta分析。
   结果：MANCAS最终分析共纳入1608例参与者。喘息的12个月发生率为15.1%。BCG接种或未接种人群间的发生率无差别（15.8% vs 14.3%; 相对危险度1.05; 95% CI, 0.94-1.19）。更新的meta分析纳入了4个新的研究：结果显示我们之前meta分析中BCG疫苗接种对哮喘发展的预防作用被减弱了(比值比0.95; 95% CI, 0.89-1.00)。BCG对致敏、湿疹/过敏性皮炎、鼻炎或一般过敏症无预防作用。
   结论：总体来说，MANCAS队列最终结果以及更新的系统回顾和meta分析提供了更清楚的证据证明BCG疫苗接种对儿童哮喘的预防作用可能是短暂的。
 

（苏楠 审校）
J Allergy Clin Immunol. 2013 Sep 28. pii: S0091-6749(13)01265-7. doi: 10.1016/j.jaci.2013.08.007. [Epub ahead of print]


 

Does BCG vaccination protect against childhood asthma? Final results from the Manchester Community Asthma Study retrospective cohort study and updated systematic review and meta-analysis.
 

Linehan MF, Nurmatov U, Frank TL, Niven RM, Baxter DN, Sheikh A.
 

ABSTRACT
BACKGROUND: The Manchester Community Asthma Study (MANCAS) found a protective effect against the risk of wheeze at age 6 to 11 years for children given neonatal BCG vaccination. Our subsequent systematic review and meta-analysis suggested that BCG vaccination did not protect against allergic sensitization but might have exerted a protective effect against nonatopic asthma.
OBJECTIVES: We sought to assess whether the protective effect of BCG vaccination on wheeze observed in the MANCAS cohort was maintained at age 13 to 17 years and to incorporate the findings from this final MANCAS analysis into an updated systematic review and meta-analysis.
METHODS: BCG vaccination status was determined from health records and respiratory outcomes from questionnaire responses. We updated the systematic review and used fixed-effects and random-effects modeling to undertake meta-analyses.
RESULTS: There were 1608 participants in the final MANCAS analysis. The 12-month prevalence of wheeze was 15.1%. There was no difference in prevalence between those who were and were not BCG vaccinated (15.8% vs 14.3%; relative risk, 1.05; 95% CI, 0.94-1.19). The updated meta-analysis incorporated 4 new studies: this showed that the protective effect of BCG vaccination against the development of asthma identified in our previous meta-analysis was attenuated (odds ratio, 0.95; 95% CI, 0.89-1.00). No protective effect of BCG was seen for sensitization, eczema/atopic dermatitis, rhinoconjunctivitis, or allergy in general.
CONCLUSIONS: Taken together, the final results of the MANCAS cohort and the updated systematic review and meta-analysis provide clearer evidence that any protective effect of BCG vaccination on childhood asthma is likely to be transient.
 

J Allergy Clin Immunol. 2013 Sep 28. pii: S0091-6749(13)01265-7. doi: 10.1016/j.jaci.2013.08.007. [Epub ahead of print]