Kato Ikuko, Koenig Karen L, Baptiste Mark S, Lillquist Patricia P, Frizzera Glauco, Burke Jerome S, Watanabe Hiroko, Shore Roy E
Department of Environmental Medicine, New York University of School of Medicine, New York, NY, USA.
Int J Cancer. 2003 Oct 20;107(1):99-105. doi: 10.1002/ijc.11356.
A population-based, incidence case-control study was conducted among women in upstate New York to determine whether histories of certain infections and antibiotic use are associated with risk of non-Hodgkin's lymphoma (NHL). Our study involved 376 cases of NHL identified through the New York State Cancer Registry and 463 controls selected from the Medicare beneficiary files and state driver's license records. Information about use of common medications including antibiotics, history of selected infectious diseases and potential confounding variables was obtained by telephone interview. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using an unconditional logistic regression model. There was a progressive increase in risk of NHL with increasing frequency and duration of systemic antibiotic use, as assessed over the period of 2-20 years before the interview. The ORs for the highest exposure categories, >/=36 episodes and >/=366 days of use, were 2.56 (95% CI 1.33-4.94) and 2.66 (95% CI 1.35-5.27), respectively. These associations were primarily due to antibiotic use against respiratory infections and dental conditions. Moreover, the association with frequency of antibiotic use for respiratory infections was pronounced for marginal zone B-cell lymphoma and for respiratory tract lymphoma. Analyses by class of antibiotics did not suggest that a general cytotoxic effect of antibiotics was responsible for these increased risks. Although recall bias and selection bias remain potential concerns in our study, the results are generally consistent with the hypothesis that persistent infection/inflammation predisposes individuals to the development of NHL. However, a direct role of antibiotics in NHL induction has not been ruled out.
在纽约州北部的女性中开展了一项基于人群的发病率病例对照研究，以确定某些感染病史和抗生素使用情况是否与非霍奇金淋巴瘤（NHL）风险相关。我们的研究纳入了通过纽约州癌症登记处确定的376例NHL病例，以及从医疗保险受益人档案和州驾照记录中选取的463名对照。通过电话访谈获取了包括抗生素在内的常用药物使用情况、特定传染病病史以及潜在混杂变量的信息。使用无条件逻辑回归模型估计比值比（OR）和95%置信区间（CI）。在访谈前2至20年期间评估发现，随着全身使用抗生素的频率和持续时间增加，NHL风险呈逐步上升趋势。最高暴露类别（使用次数≥36次和使用天数≥366天）的OR分别为2.56（95%CI 1.33 - 4.94）和2.66（95%CI 1.35 - 5.27）。这些关联主要归因于针对呼吸道感染和牙科疾病使用抗生素。此外，对于边缘区B细胞淋巴瘤和呼吸道淋巴瘤，抗生素用于呼吸道感染的频率与之关联显著。按抗生素类别进行的分析并未表明抗生素的一般细胞毒性作用是这些风险增加的原因。尽管回忆偏倚和选择偏倚在我们的研究中仍是潜在问题，但结果总体上与持续感染/炎症使个体易患NHL这一假设一致。然而，抗生素在NHL诱发中的直接作用尚未排除。
