早期感染暴露与儿童发病多发性硬化症的风险增加无关。
Early infectious exposures are not associated with increased risk of pediatric-onset multiple sclerosis.
机构信息
Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA.
Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA.
出版信息
Mult Scler Relat Disord. 2018 May;22:103-107. doi: 10.1016/j.msard.2018.03.015. Epub 2018 Mar 26.
OBJECTIVE
We sought to determine if early infectious exposures such as daycare, early use of antibiotics, vaccinations and other germ exposures including pacifier use and playing on grass are associated with multiple sclerosis (MS) risk in children.
METHODS
This was a case-control study of children with MS or clinically isolated syndrome (CIS) and healthy controls enrolled at sixteen clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire that captured early infectious exposures, habits, and illnesses in the first five years of life. A panel of at least two pediatric MS specialists confirmed diagnosis of participants. Association of early infectious variables with diagnosis was assessed via multivariable logistic regression analyses, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status (SES).
RESULTS
Questionnaire responses for 326 eligible cases (mean age 14.9, 63.5% girls) and 506 healthy pediatric subjects (mean age 14.4, 56.9% girls) were included in analyses. History of flu with high fever before age five (p = 0.01), playing outside in grass and use of special products to treat head lice or scabies (p = 0.04) were associated with increased risk of MS in unadjusted analyses. In the multivariable model adjusted for age, sex, race, ethnicity, and mother's highest educational attainment, these results were not statistically significant. Notably, antibiotic use (p = 0.22) and regular daycare attendance before age 6 (p = 0.09) were not associated with odds of developing MS.
CONCLUSION
Early infectious factors investigated in this study were not associated with MS risk.
目的
我们旨在确定儿童时期早期的感染暴露（如日托、早期使用抗生素、疫苗接种和其他细菌暴露，包括使用安抚奶嘴和在草地上玩耍）是否与多发性硬化症（MS）的风险相关。
方法
这是一项病例对照研究，纳入了在参与美国儿科多发性硬化症中心网络的 16 个诊所就诊的 MS 患儿或临床孤立综合征（CIS）患儿及健康对照者。父母完成了一份全面的环境调查问卷，该问卷涵盖了儿童前五年的早期感染暴露、习惯和疾病。由至少两名儿科多发性硬化症专家组成的小组确认了参与者的诊断。通过多变量逻辑回归分析评估早期感染变量与诊断之间的关联，同时调整年龄、性别、种族、民族、美国出生地区和社会经济状况（SES）。
结果
纳入了 326 例符合条件的病例（平均年龄 14.9 岁，63.5%为女孩）和 506 例健康儿科对照者（平均年龄 14.4 岁，56.9%为女孩）的调查问卷应答。5 岁前有高热流感史（p=0.01）、在草地上玩耍和使用特殊产品治疗头虱或疥疮（p=0.04）与未经调整分析中 MS 风险增加相关。在调整年龄、性别、种族、民族和母亲最高教育程度后，这些结果在多变量模型中无统计学意义。值得注意的是，抗生素使用（p=0.22）和 6 岁前定期入托（p=0.09）与 MS 发病几率无关。
结论
本研究中调查的早期感染因素与 MS 风险无关。
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