儿童急性淋巴细胞白血病与早期免疫刺激指标：埃斯特尔研究（SFCE）
Childhood acute lymphoblastic leukaemia and indicators of early immune stimulation: the Estelle study (SFCE).
作者信息
Ajrouche R, Rudant J, Orsi L, Petit A, Baruchel A, Lambilliotte A, Gambart M, Michel G, Bertrand Y, Ducassou S, Gandemer V, Paillard C, Saumet L, Blin N, Hémon D, Clavel J
机构信息
1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Sud University, Le Kremlin Bicêtre, France.
1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France [3] RNHE-National Registry of Childhood Hematopoietic Malignancies, Villejuif, France.
出版信息
Br J Cancer. 2015 Mar 17;112(6):1017-26. doi: 10.1038/bjc.2015.53.
BACKGROUND
Factors related to early stimulation of the immune system (breastfeeding, proxies for exposure to infectious agents, normal delivery, and exposure to animals in early life) have been suggested to decrease the risk of childhood acute lymphoblastic leukaemia (ALL).
METHODS
The national registry-based case-control study, ESTELLE, was carried out in France in 2010-2011. Population controls were frequency matched with cases on age and gender. The participation rates were 93% for cases and 86% for controls. Data were obtained from structured telephone questionnaires administered to mothers. Odds ratios (OR) were estimated using unconditional regression models adjusted for age, gender, and potential confounders.
RESULTS
In all, 617 ALL and 1225 controls aged ⩾1 year were included. Inverse associations between ALL and early common infections (OR=0.8, 95% confidence interval (CI): 0.6, 1.0), non-first born (⩾3 vs 1; OR=0.7, 95% CI: 0.5, 1.0), attendance of a day-care centre before age 1 year (OR=0.7, 95% CI: 0.5, 1.0), breastfeeding (OR=0.8, 95% CI: 0.7, 1.0), and regular contact with pets (OR=0.8, 95% CI: 0.7, 1.0) in infancy were observed.
CONCLUSIONS
The results support the hypothesis that conditions promoting the maturation of the immune system in infancy have a protective role with respect to ALL.
背景
有研究表明，与免疫系统早期刺激相关的因素（母乳喂养、接触感染源的替代指标、顺产以及早年接触动物）可降低儿童急性淋巴细胞白血病（ALL）的发病风险。
方法
2010 - 2011年在法国开展了基于全国登记处的病例对照研究ESTELLE。人群对照在年龄和性别上与病例进行频率匹配。病例的参与率为93%，对照的参与率为86%。数据通过对母亲进行的结构化电话问卷调查获得。使用经年龄、性别和潜在混杂因素调整的无条件回归模型估计比值比（OR）。
结果
共纳入617例年龄≥1岁的ALL患者和1225例对照。观察到ALL与早期常见感染（OR = 0.8，95%置信区间（CI）：0.6，1.0）、非头胎（≥3胎与1胎相比；OR = 0.7，95% CI：0.5，1.0）、1岁前入托（OR = 0.7，95% CI：0.5，1.0）、母乳喂养（OR = 0.8，95% CI：0.7，1.0）以及婴儿期经常与宠物接触（OR = 0.8，95% CI：0.7，1.0）之间存在负相关。
结论
结果支持以下假设，即促进婴儿期免疫系统成熟的条件对ALL具有保护作用。
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