Metsälä J, Lundqvist A, Virta L J, Kaila M, Gissler M, Virtanen S M
Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland.
Clin Exp Allergy. 2015 Jan;45(1):137-45. doi: 10.1111/cea.12356.
Evidence on the association between post-natal exposure to antibiotics and the development of asthma is extensive, but inconsistent and even less is known about prenatal exposure.
The aim of this study was to examine the associations between prenatal and post-natal exposure to different antibiotics and the risk of childhood asthma in a population- and register-based nested case-control study.
All children who were born in 1996-2004 in Finland and diagnosed with asthma by 2006 were identified from a national health register. For each case, one matched control was selected. Information on asthma diagnoses, purchased anti-asthmatic drugs and antibiotics as well as putative confounders was obtained from national health registries. The associations were analysed using conditional logistic regression for children diagnosed at the age of 3 years or later (n = 6 690 case-control pairs).
Maternal use of any antibiotics during pregnancy was associated with an increased risk of asthma in the offspring [adjusted odds ratio (OR) = 1.31 (95% confidence interval (CI): 1.21-1.42)]. Several maternal specific antibiotics were associated with the risk of asthma, and the strongest association was observed for cephalosporins [OR = 1.46 (95% CI 1.30-1.64)]. Child's use of antibiotics during the first year of life was associated with an increased risk of asthma [OR = 1.60 (95% CI 1.48-1.73)]. Child's use of cephalosporins [OR = 1.79 (95% CI 1.59-2.01)], sulphonamides and trimethoprim [OR = 1.65 (95% CI 1.34-2.02)], macrolides [OR = 1.61 (95% CI 1.46-1.78)] and amoxicillin [OR = 1.46 (95% CI 1.35-1.58)] was associated with an increased risk of asthma.
Both prenatal and post-natal exposure to antibiotics was associated with an increased risk of asthma. The potential role of adverse effects of antibiotics on the gut microbiota and the development of asthma should be further explored.
关于产后接触抗生素与哮喘发病之间关联的证据广泛，但并不一致，而关于产前接触抗生素的情况则知之更少。
本研究旨在通过一项基于人群和登记数据的巢式病例对照研究，探讨产前和产后接触不同抗生素与儿童哮喘风险之间的关联。
从芬兰国家健康登记处识别出所有在1996 - 2004年出生且截至2006年被诊断为哮喘的儿童。为每个病例选取一名匹配的对照。从国家健康登记处获取有关哮喘诊断、购买的抗哮喘药物和抗生素以及可能的混杂因素的信息。对3岁及以上诊断的儿童（n = 6690例病例对照对）使用条件逻辑回归分析这些关联。
孕期母亲使用任何抗生素都与后代哮喘风险增加相关[调整后的优势比（OR）= 1.31（95%置信区间（CI）：1.21 - 1.42）]。几种母亲使用的特定抗生素与哮喘风险相关，其中头孢菌素的关联最强[OR = 1.46（95% CI 1.30 - 1.64）]。儿童在生命的第一年使用抗生素与哮喘风险增加相关[OR = 1.60（95% CI 1.48 - 1.73）]。儿童使用头孢菌素[OR = 1.79（95% CI 1.59 - 2.01）]、磺胺类药物和甲氧苄啶[OR = 1.65（95% CI 1.34 - 2.02）]、大环内酯类药物[OR = 1.61（95% CI 1.46 - 1.78）]和阿莫西林[OR = 1.46（95% CI 1.35 - 1.58）]均与哮喘风险增加相关。
产前和产后接触抗生素均与哮喘风险增加相关。抗生素对肠道微生物群的不良影响以及哮喘发展的潜在作用应进一步探索。
