内毒素暴露：美国相关哮喘结局的预测因素及患病率
Endotoxin Exposure: Predictors and Prevalence of Associated Asthma Outcomes in the United States.
作者信息
Thorne Peter S, Mendy Angelico, Metwali Nervana, Salo Päivi, Co Caroll, Jaramillo Renee, Rose Kathryn M, Zeldin Darryl C
机构信息
1 Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa.
2 Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina; and.
出版信息
Am J Respir Crit Care Med. 2015 Dec 1;192(11):1287-97. doi: 10.1164/rccm.201502-0251OC.
RATIONALE
Inhaled endotoxin induces airway inflammation and is an established risk factor for asthma. The 2005-2006 National Health and Nutrition Examination Survey included measures of endotoxin and allergens in homes as well as specific IgE to inhalant allergens.
OBJECTIVES
To understand the relationships between endotoxin exposure, asthma outcomes, and sensitization status for 15 aeroallergens in a nationally representative sample.
METHODS
Participants were administered questionnaires in their homes. Reservoir dust was vacuum sampled to generate composite bedding and bedroom floor samples. We analyzed 7,450 National Health and Nutrition Examination Survey dust and quality assurance samples for their endotoxin content using extreme quality assurance measures. Data for 6,963 subjects were available, making this the largest study of endotoxin exposure to date. Log-transformed endotoxin concentrations were analyzed using logistic models and forward stepwise linear regression. Analyses were weighted to provide national prevalence estimates and unbiased variances.
MEASUREMENTS AND MAIN RESULTS
Endotoxin exposure was significantly associated with wheeze in the past 12 months, wheeze during exercise, doctor and/or emergency room visits for wheeze, and use of prescription medications for wheeze. Models adjusted for age, sex, race and/or ethnicity, and poverty-to-income ratio and stratified by allergy status showed that these relationships were not dependent upon sensitization status but were worsened among those living in poverty. Significant predictors of higher endotoxin exposures were lower family income; Hispanic ethnicity; participant age; dog(s), cat(s), cockroaches, and/or smoker(s) in the home; and carpeted floors.
CONCLUSIONS
In this U.S. nationwide representative sample, higher endotoxin exposure was significantly associated with measures of wheeze, with no observed protective effect regardless of sensitization status.
原理
吸入内毒素可诱发气道炎症，是哮喘的既定危险因素。2005 - 2006年全国健康与营养检查调查涵盖了家庭中内毒素和过敏原的测量以及对吸入性过敏原的特异性IgE检测。
目的
在具有全国代表性的样本中，了解15种气传过敏原的内毒素暴露、哮喘结局和致敏状态之间的关系。
方法
研究人员在参与者家中发放问卷。通过真空采样收集储尘，以生成综合被褥和卧室地板样本。我们采用极端质量保证措施，分析了7450份全国健康与营养检查调查的灰尘及质量保证样本中的内毒素含量。获得了6963名受试者的数据，这使其成为迄今为止关于内毒素暴露的最大规模研究。使用逻辑模型和向前逐步线性回归分析对数转换后的内毒素浓度。分析进行了加权，以提供全国患病率估计值和无偏方差。
测量指标与主要结果
在过去12个月内，内毒素暴露与喘息、运动时喘息、因喘息就医和/或急诊以及使用喘息处方药显著相关。针对年龄、性别、种族和/或族裔以及贫困与收入比进行调整并按过敏状态分层的模型显示，这些关系并不依赖于致敏状态，但在贫困人群中更为严重。内毒素暴露较高的显著预测因素包括家庭收入较低、西班牙裔族裔、参与者年龄、家中养狗、猫、蟑螂和/或吸烟者以及铺有地毯的地板。
结论
在这个具有美国全国代表性的样本中，较高的内毒素暴露与喘息指标显著相关，无论致敏状态如何，均未观察到保护作用。
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