儿童哮喘与1岁以前抗生素暴露的关系的Meta分析及临床研究

发布时间：2018-04-11 19:55

本文选题：病例对照 + 哮喘　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:通过对前瞻性队列研究进行Meta分析,得到相关的循证医学证据,来评估1岁以前使用抗生素与儿童时期哮喘的关系。再通过进行相应的病例对照研究,验证本Meta分析的结果是否适用于国内儿童。有助于规范生命早期抗生素的合理应用,为未来找到预防和治疗哮喘的方法和靶标提供依据。方法:1、检索中国知网数据库、中国维普科技期刊数据库、万方数据库、Pub Med、EBSCO等中英文数据库关于儿童哮喘与其1岁以前使用抗菌药物的关系的前瞻性队列研究,采用Stata12.0软件,通过Meta分析方法探讨二者之间的关系。2、选择2016年6月-2016年12月在我院住院的首次诊断哮喘的患儿作为实验组。同时选取附近4家幼儿园、托儿所的健康儿童,其性别比例、年龄相仿的健康儿童作为对照组。采用问卷调查的方式,根据国际儿童哮喘过敏研究(ISAAC)公认的哮喘的发病原因进行调查。运用spss19.0对各暴露因素与疾病的关系进行分析,采用多因素逻辑回归建立模型,分析1岁以前抗生素的暴露与哮喘的关系。结果:1、选取文献质量评分高并且调整了呼吸道感染因素的效应值进行合并,共纳入7项研究。Meta分析结果显示,1岁以内抗菌药物的使用增加了儿童哮喘的风险(OR=1.13,95%CI:1.10~1.17,P0.05);1年内使用抗菌药物4次与使用0~1次相比哮喘风险增加(OR=1.28,95%CI:1.19~1.38,P0.05);高风险儿童(至少有1位直系亲属曾患有哮喘)1岁以前使用抗生素罹患哮喘的风险与没有使用抗生素的高危儿童相比增加(OR=1.47,95%CI:1.20~1.81,P0.05)。2、分析纳入实验组196位患儿,对照组205为健康儿童。对各暴露因素进行分析结果显示剖宫产、过敏性疾病家族史、近1年呼吸道感染大于6次、1岁以前及新生儿期抗生素的暴露被认为是危险因素,母乳喂养是保护因素。其中近1年呼吸道感染6次以上对模型的影响最大,调整呼吸道感染的因素1岁以内抗生素的分析结果为OR=2.354,95%CI(1.478~3.750)。另外1岁以内抗生素的使用2-3次数与使用1次比较,虽然P0.05,OR=1.131,95%CI(0.574~2.228)使用4次与使用1次比较有显著的统计学差异,OR=2.320,95%CI(1.237~4.352)可以看出,随着抗生素使用次数的增加哮喘的风险增加。结论:1、生后1年内使用抗菌药物增加儿童哮喘的风险;高风险儿童使用抗菌药物增加哮喘的风险;抗菌药物使用次数增加与哮喘风险增加有关,但具体的剂量关系有待进一步研究。2、1岁以内抗生素的暴露增加了儿童时期罹患哮喘的风险,且抗生素的使用次数越多则儿童时期罹患哮喘的风险越大。但由于本研究的样本量偏小,只能在一定程度上说明问题,未来有待进一步增大样本量进行研究。
[Abstract]:Objective: to evaluate the relationship between antibiotic use and childhood asthma before age 1 by Meta analysis of prospective cohort studies and relevant evidence-based medical evidence.A case-control study was conducted to verify the applicability of this Meta analysis to children in China.It is helpful to standardize the rational use of antibiotics in early life and to provide evidence for the prevention and treatment of asthma in the future.Methods: a prospective cohort study on the relationship between childhood asthma and the use of antimicrobial agents before the age of one year was searched in Chinese and English databases such as China knowledge Web Database, China Weip Science and Technology Journal Database, Wanfang Database, Pub MedBesco and so on. Stata12.0 software was used.To explore the relationship between them by Meta analysis, we selected the children who were hospitalized in our hospital from June 2016 to December 2016 as the experimental group.At the same time, the healthy children in 4 nearby kindergartens and nurseries were selected as the control group.The causes of asthma were investigated by questionnaire according to ISAAC, an international study of asthma allergy in children.Spss19.0 was used to analyze the relationship between various exposure factors and diseases, and multivariate logistic regression was used to establish a model to analyze the relationship between antibiotics exposure and asthma before one year of age.Results: 1, the literature quality score was high and the effect value of respiratory infection factors was adjusted for consolidation.The immediate family members had suffered from asthma before the age of one year, and the risk of developing asthma with antibiotics before the age of one year was higher than that of the high-risk children who did not use antibiotics. The analysis included 196 children in the experimental group.Control group 205 were healthy children.The analysis of exposure factors showed that the exposure of antibiotics before 1 year old and newborn stage was considered to be a risk factor and breast feeding was a protective factor in the family history of cesarean section and allergic diseases.The influence of respiratory tract infection more than 6 times in the last year on the model was the most significant. The results of the analysis of antibiotics within 1 year old adjusted for respiratory tract infection were as follows: ORN 2.354 ~ 95CII 1.478 ~ 3.750.Conclusion: one year after birth, the use of antimicrobial agents increases the risk of asthma in children, and the use of antibiotics increases the risk of asthma in high-risk children, and the increase in the frequency of use of antibiotics is related to the increased risk of asthma.However, the specific dose relationship needs to be further studied. Exposure to antibiotics less than 1 year old increases the risk of asthma in children, and the more antibiotics are used, the greater the risk of asthma in children.However, because the sample size of this study is too small, it can only explain the problem to some extent, and further increase the sample size is needed to be studied in the future.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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