Schlinzig Titus, Johansson Stefan, Stephansson Olof, Hammarström Lennart, Zetterström Rolf H, von Döbeln Ulrika, Cnattingius Sven, Norman Mikael
Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
PLoS One. 2017 Sep 14;12(9):e0184748. doi: 10.1371/journal.pone.0184748. eCollection 2017.
Birth by cesarean section is associated with increased risks of immune disorders. We tested whether establishment of immune function at birth relates to mode of delivery, taking other maternal and infant characteristics into account.
Using a prospectively collected database, we retrieved information on maternal and infant characteristics of 6,014 singleton infants delivered from February to April 2014 in Stockholm, Sweden, with gestational age ≥35 weeks, Apgar scores ≥7, and without congenital malformations or any neonatal morbidity. We linked our data to blood levels of T-cell receptor excision circles (TREC) and κ-deleting recombination excision circles (KREC), determined as part of a neonatal screening program for immune-deficiencies, and representing quantities of newly formed T- and B-lymphocytes. Multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for participants having TREC and KREC levels in the lowest quintile. Multivariate models were adjusted for postnatal age at blood sampling, and included perinatal (mode of delivery, infant sex, gestational age, and birth weight for gestational age), and maternal characteristics (age, parity, BMI, smoking, diabetes, and hypertensive disease). Low TREC was associated with cesarean section before labor (adjusted OR:1.32 [95% CI 1.08-1.62]), male infant sex (aOR:1.60 [1.41-1.83]), preterm birth at 35-36 weeks of gestation (aOR:1.89 [1.21-2.96]) and small for gestational age (aOR:1.67 [1.00-2.79]). Low KREC was associated with male sex (aOR:1.32 [1.15-1.50]), postterm birth at ≥42 weeks (aOR:1.43 [1.13-1.82]) and small for gestational age (aOR:2.89 [1.78-4.69]). Maternal characteristics showed no consistent associations with neonatal levels of either TREC or KREC.
Cesarean section before labor was associated with lower T-lymphocyte formation, irrespective of maternal characteristics, pregnancy, and neonatal risk factors. The significance of a reduced birth-related surge in lymphocyte formation for future immune function and health remains to be investigated.
剖宫产与免疫紊乱风险增加有关。我们在考虑其他母婴特征的情况下，测试了出生时免疫功能的建立是否与分娩方式有关。
利用前瞻性收集的数据库，我们检索了2014年2月至4月在瑞典斯德哥尔摩分娩的6014名单胎婴儿的母婴特征信息，这些婴儿的孕周≥35周，阿氏评分≥7，且无先天性畸形或任何新生儿疾病。我们将数据与作为免疫缺陷新生儿筛查项目一部分测定的T细胞受体切除环（TREC）和κ缺失重组切除环（KREC）的血液水平相关联，它们代表新形成的T淋巴细胞和B淋巴细胞的数量。多因素逻辑回归用于计算TREC和KREC水平处于最低五分位数的参与者的比值比（OR）及95%置信区间（CI）。多因素模型根据采血时的出生后年龄进行了调整，并纳入了围产期因素（分娩方式、婴儿性别、孕周和孕周别出生体重）以及母亲特征（年龄、产次、BMI、吸烟、糖尿病和高血压疾病）。低TREC与临产前剖宫产（调整后OR：1.32 [95% CI 1.08 - 1.62]）、男婴性别（调整后OR：1.60 [1.41 - 1.83]）、孕35 - 36周早产（调整后OR：1.89 [1.21 - 2.96]）和小于胎龄儿（调整后OR：1.67 [1.00 - 2.79]）有关。低KREC与男性性别（调整后OR：1.32 [1.15 - 1.50]）、≥42周过期产（调整后OR：1.43 [1.13 - 1.82]）和小于胎龄儿（调整后OR：2.89 [1.78 - 4.69]）有关。母亲特征与新生儿TREC或KREC水平均无一致关联。
临产前剖宫产与较低的T淋巴细胞形成有关，与母亲特征、妊娠和新生儿危险因素无关。出生时淋巴细胞形成相关激增减少对未来免疫功能和健康的意义仍有待研究。
Zotero 插件
