Jedrychowski Wieslaw, Perera Frederica P, Maugeri Umberto, Mrozek-Budzyn Dorota, Mroz Elzbieta, Flak Elzbieta, Edwards Susan, Spengler John D, Jacek Ryszard, Sowa Agata, Musiał Agnieszka
Epidemiology and Preventive Medicine, Coll. Med. Jagiellonian University in Krakow, Poland.
Environ Int. 2009 Aug;35(6):877-84. doi: 10.1016/j.envint.2009.03.004. Epub 2009 Apr 26.
The main goal of the paper was to assess the pattern of risk factors having an impact on the onset of early wheezing phenotypes in the birth cohort of 468 two-year olds and to investigate the severity of respiratory illness in the two-year olds in relation to both wheezing phenotypes, environmental tobacco smoke (ETS) and personal PM(2.5) exposure over pregnancy period (fine particulate matter). The secondary goal of the paper was to assess possible association of early persistent wheezing with the length of the baby at birth. Pregnant women were recruited from ambulatory prenatal clinics in the first and second trimester of pregnancy. Only women 18-35 years of age, who claimed to be non-smokers, with singleton pregnancies, without illicit drug use and HIV infection, free from chronic diseases were eligible for the study. In the statistical analysis of respiratory health of children multinomial logistic regression and zero-inflated Poisson regression models were used. Approximately one third of the children in the study sample experienced wheezing in the first 2 years of life and in about two third of cases (67%) the symptom developed already in the first year of life. The early wheezing was easily reversible and in about 70% of infants with wheezing the symptom receded in the second year of life. The adjusted relative risk ratio (RRR) of persistent wheezing increased with maternal atopy (RRR=3.05; 95%CI: 1.30-7.15), older siblings (RRR=3.05; 95%CI: 1.67-5.58) and prenatal ETS exposure (RRR=1.13; 95%CI: 1.04-1.23), but was inversely associated with the length of baby at birth (RRR=0.88; 95%CI: 0.76-1.01). The adjusted incidence risk ratios (IRR) of coughing, difficult breathing, runny/stuffy nose and pharyngitis/tonsillitis in wheezers were much higher than that observed among non-wheezers and significantly depended on prenatal PM(2.5) exposure, older siblings and maternal atopy. The study shows a clear inverse association between maternal age or maternal education and respiratory illnesses and calls for more research efforts aiming at the explanation of factors hidden behind proxy measures of quality of maternal care of babies. The data support the hypothesis that burden of respiratory symptoms in early childhood and possibly in later life may be programmed already in prenatal period when the respiratory system is completing its growth and maturation.
该论文的主要目标是评估影响468名两岁儿童出生队列中早期喘息表型发病的风险因素模式，并调查两岁儿童呼吸系统疾病的严重程度与喘息表型、环境烟草烟雾（ETS）以及孕期个人PM2.5暴露（细颗粒物）之间的关系。该论文的次要目标是评估早期持续性喘息与出生时婴儿身长之间可能存在的关联。孕妇在妊娠的前三个月和第二个月从门诊产前诊所招募。只有年龄在18至35岁之间、自称不吸烟、单胎妊娠、无非法药物使用和HIV感染且无慢性病的女性才有资格参与该研究。在对儿童呼吸健康的统计分析中，使用了多项逻辑回归和零膨胀泊松回归模型。研究样本中约三分之一的儿童在生命的前两年出现喘息，约三分之二的病例（67%）在生命的第一年就出现了症状。早期喘息很容易逆转，约70%的喘息婴儿在生命的第二年症状消退。持续性喘息的调整相对风险比（RRR）随着母亲过敏症（RRR = 3.05；95%置信区间：1.30 - 7.15）、年长兄弟姐妹（RRR = 3.05；95%置信区间：1.67 - 5.58）和产前ETS暴露（RRR = 1.13；95%置信区间：1.04 - 1.23）而增加，但与出生时婴儿的身长呈负相关（RRR = 0.88；95%置信区间：0.76 - 1.01）。喘息儿童咳嗽、呼吸困难、流鼻涕/鼻塞和咽炎/扁桃体炎的调整发病风险比（IRR）远高于非喘息儿童，并且显著取决于产前PM2.5暴露、年长兄弟姐妹和母亲过敏症。该研究表明母亲年龄或母亲教育程度与呼吸系统疾病之间存在明显的负相关，并呼吁进行更多研究，以解释婴儿母亲护理质量替代指标背后隐藏的因素。数据支持这样一种假设，即儿童早期乃至可能在以后生活中的呼吸道症状负担可能在产前就已编程，此时呼吸系统正在完成其生长和成熟。
