剖宫产术与免疫功能相关疾病。

Cesarean section and disease associated with immune function.

机构信息

Pediatric Department, University Hospital Naestved, Naestved, Denmark.

Research Unit for Woman's and Children's Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

出版信息

J Allergy Clin Immunol. 2016 Feb;137(2):587-90. doi: 10.1016/j.jaci.2015.07.040. Epub 2015 Sep 12.

DOI:10.1016/j.jaci.2015.07.040

PMID:26371844

Abstract

BACKGROUND

Earlier studies have shown that delivery by cesarean section (CS) is associated with an increased risk of disease associated with immune function in the offspring, but these studies have generally not discriminated between the effect of acute and elective CS.

OBJECTIVE

We sought to further explore these associations using discrimination between the effects of acute versus elective CS.

METHODS

We performed a population- and national register-based cohort study including all children born in Denmark from January 1997 through December 2012. Hazard ratios for diseases associated with immune function in children delivered by acute and elective CS with vaginal delivery as the reference were calculated by using Cox regression. All analyses were adjusted for gestational age, sex, birth weight, maternal age, maternal smoking during pregnancy, and complications during pregnancy (preeclampsia, eclampsia, hemorrhage, and hyperemesis).

RESULTS

A total of 750,569 children aged 0 to 14 years were included. Children delivered by both acute and elective CS had an increased risk of asthma, laryngitis, and gastroenteritis. Children delivered by acute CS had an increased risk of ulcerative colitis and celiac disease, whereas children delivered by elective CS had an increased risk of lower respiratory tract infection and juvenile idiopathic arthritis. The effect of elective CS was higher than the effect of acute CS on the risk of asthma.

CONCLUSION

Children delivered by CS are at increased risk of disease associated with immune function. The effect is mainly on diseases involving the mucosal immune system.

摘要

背景

早期的研究表明，剖宫产（CS）分娩与后代免疫功能相关疾病的风险增加有关，但这些研究通常没有区分急性 CS 和选择性 CS 的影响。

目的

我们试图通过区分急性 CS 和选择性 CS 的影响来进一步探讨这些关联。

方法

我们进行了一项基于人群和国家登记的队列研究，纳入了 1997 年 1 月至 2012 年 12 月期间在丹麦出生的所有儿童。通过 Cox 回归计算了急性 CS 和选择性 CS 分娩与阴道分娩相比，与免疫功能相关疾病的风险比。所有分析均调整了胎龄、性别、出生体重、产妇年龄、妊娠期间吸烟以及妊娠并发症（子痫前期、子痫、出血和妊娠剧吐）。

结果

共纳入了 750569 名 0 至 14 岁的儿童。急性 CS 和选择性 CS 分娩的儿童患哮喘、喉炎和胃肠炎的风险增加。急性 CS 分娩的儿童患溃疡性结肠炎和乳糜泻的风险增加，而选择性 CS 分娩的儿童患下呼吸道感染和幼年特发性关节炎的风险增加。选择性 CS 的影响高于急性 CS 对哮喘风险的影响。