家族病史与环境因素对婴儿期呼吸道相关发病率的交互作用。

Interactive effect of family history and environmental factors on respiratory tract-related morbidity in infancy.

作者信息

Kuiper Sandra, Muris Jean W M, Dompeling Edward, Kester Arnold D M, Wesseling Geertjan, Knottnerus J André, van Schayck Constant P

机构信息

Department of General Practice, Care and Public Health Research Institute, University of Maastricht, Maastricht, The Netherlands.

出版信息

J Allergy Clin Immunol. 2007 Aug;120(2):388-95. doi: 10.1016/j.jaci.2007.03.038. Epub 2007 May 10.

DOI:10.1016/j.jaci.2007.03.038

PMID:17498791

Abstract

BACKGROUND

Family and environmental factors affect the development of respiratory morbidity. How these factors interact is unclear.

OBJECTIVE

We sought to clarify the interactive effect of family history of asthma and environmental factors on the occurrence of respiratory morbidity.

METHODS

Two hundred twenty-one infants with a positive family history of asthma (PFH) and 308 with a negative family history of asthma (NFH) were prenatally selected and followed until the age of 2 years. Exposure to environmental factors and the occurrence of respiratory morbidity were recorded. By using multiple logistic regression analysis, increased risk was expressed in odds ratios (ORs) adjusted for relevant covariables.

RESULTS

Infants with a PFH had more respiratory morbidity than infants with an NFH. Adjusted ORs ranged from 1.7 (95% CI, 1.0-2.8) for expiratory wheezing to 4.9 (95% CI, 1.7-13.6) for croup. Parental smoking increased the OR of a PFH for wheezing ever (OR, 5.8 [95% CI, 2.5-13.8]) and attacks of wheezing (OR, 6.8 [95% CI, 2.7-16.9]), as did Der p 1 (OR, 10.2 [95% CI, 2.8-36.3] and OR, 7.1 [95% CI, 7.1-21.0], respectively). Exposure to both parental smoking and Der p 1 further increased this OR (OR, 30.8 [95%, CI, 6.9-137.2] and OR, 26.2 [95% CI, 5.9-115.6], respectively). Breast-feeding decreased the ORs of PFH for tonsillitis and acute otitis media: the increased ORs for these diagnoses in formula-fed infants with PFHs versus those with NFHs (OR, 9.2 [95% CI, 2.1-39.7] and OR, 2.9 [95% CI, 1.1-7.2], respectively) was attenuated in breast-fed infants (OR, 1.8 [95% CI, 0.8-3.8] and OR, 0.7 [95% CI, 0.4-1.3]).

CONCLUSION

Parental smoking and Der p 1 increase the effect of a PFH on respiratory morbidity. Breast-feeding reduces this effect.

CLINICAL IMPLICATIONS

Extra attention should be given to stimulate mothers to breast-feed their children in case they cannot stop smoking or taking sanitation measures.

摘要

背景

家庭和环境因素会影响呼吸道疾病的发生发展。这些因素如何相互作用尚不清楚。

目的

我们试图阐明哮喘家族史与环境因素对呼吸道疾病发生的交互作用。

方法

产前选取221名有哮喘家族史阳性（PFH）的婴儿和308名有哮喘家族史阴性（NFH）的婴儿，并随访至2岁。记录环境因素暴露情况及呼吸道疾病的发生情况。通过多因素逻辑回归分析，以调整相关协变量后的比值比（OR）表示风险增加情况。

结果

有PFH的婴儿比有NFH的婴儿患呼吸道疾病更多。调整后的OR范围从呼气性喘息的1.7（95%CI，1.0 - 2.8）到喉炎的4.9（95%CI，1.7 - 13.6）。父母吸烟增加了PFH婴儿患喘息（OR，5.8 [95%CI，2.5 - 13.8]）及喘息发作（OR，6.8 [95%CI，2.7 - 16.9]）的OR，粉尘螨1（Der p 1）也有类似情况（分别为OR，10.2 [95%CI，2.8 - 36.3] 和OR，7.1 [95%CI，7.1 - 21.0]）。同时暴露于父母吸烟和Der p 1会进一步增加该OR（分别为OR，30.8 [95%，CI，6.9 - 137.2] 和OR，26.2 [95%CI，5.9 - 115.6]）。母乳喂养降低了PFH婴儿患扁桃体炎和急性中耳炎的OR：与NFH婴儿相比，PFH配方奶喂养婴儿患这些疾病的OR增加（分别为OR，9.2 [95%CI，2.1 - 39.7] 和OR，2.9 [95%CI，1.1 - 7.2]），而母乳喂养婴儿则减弱（分别为OR，1.8 [95%CI，0.8 - 3.8] 和OR，0.7 [95%CI，0.4 - 1.3]）。