Center for Perinatal, Pediatric and Environmental Epidemiology, Yale University School of Public Health, New Haven, CT 06510-3210, USA.
Pediatrics. 2011 Jun;127(6):1125-38. doi: 10.1542/peds.2010-2092. Epub 2011 May 23.
The increasing prevalence of childhood asthma has been associated with low microbial exposure as described by the hygiene hypothesis.
We sought to evaluate the evidence of association between antibiotic exposure during pregnancy or in the first year of life and risk of childhood asthma.
PubMed was systematically searched for studies published between 1950 and July 1, 2010. Those that assessed associations between antibiotic exposure during pregnancy or in the first year of life and asthma at ages 0 to 18 years (for pregnancy exposures) or ages 3 to 18 years (for first-year-of-life exposures) were included. Validity was assessed according to study design, age at asthma diagnosis, adjustment for respiratory infections, and consultation rates.
For exposure in the first year of life, the pooled odds ratio (OR) for all studies (N = 20) was 1.52 (95% confidence interval [CI]: 1.30-1.77). Retrospective studies had the highest pooled risk estimate for asthma (OR: 2.04 [95% CI: 1.83-2.27]; n = 8) compared with database and prospective studies (OR: 1.25 [95% CI: 1.08-1.45]; n = 12). Risk estimates for studies that adjusted for respiratory infections (pooled OR: 1.16 [95% CI: 1.08-1.25]; n = 5) or later asthma onset (pooled OR for asthma at or after 2 years: OR: 1.16 [95% CI: 1.06-1.25]; n = 3) were weaker but remained significant. For exposure during pregnancy (n = 3 studies), the pooled OR was 1.24 (95% CI: 1.02-1.50).
Antibiotics seem to slightly increase the risk of childhood asthma. Reverse causality and protopathic bias seem to be possible confounders for this relationship.
正如卫生假说所描述的，儿童哮喘的发病率不断上升与微生物暴露水平低有关。
我们旨在评估孕期或婴儿期使用抗生素与儿童哮喘风险之间的关联性证据。
系统检索了 1950 年至 2010 年 7 月 1 日期间发表的文献，评估了孕期或婴儿期使用抗生素与 0 至 18 岁（孕期暴露）或 3 至 18 岁（婴儿期暴露）时哮喘之间的关联性。根据研究设计、哮喘诊断年龄、呼吸道感染调整和就诊率评估有效性。
对于婴儿期的暴露，20 项研究的汇总比值比（OR）为 1.52（95%置信区间[CI]：1.30-1.77）。回顾性研究的哮喘汇总风险估计值最高（OR：2.04 [95% CI：1.83-2.27]；n=8），高于数据库和前瞻性研究（OR：1.25 [95% CI：1.08-1.45]；n=12）。调整呼吸道感染（汇总 OR：1.16 [95% CI：1.08-1.25]；n=5）或哮喘发病较晚（汇总 OR 哮喘发病在 2 年或以后：OR：1.16 [95% CI：1.06-1.25]；n=3）的研究风险估计值较弱，但仍有统计学意义。对于孕期暴露（n=3 项研究），汇总 OR 为 1.24（95% CI：1.02-1.50）。
抗生素似乎略微增加了儿童哮喘的风险。可能的混杂因素包括反向因果关系和前驱性偏倚。
