Kramer M S
Department of Pediatrics, McGill University Faculty of Medicine, Montréal, Québec, Canada.
J Pediatr. 1988 Feb;112(2):181-90. doi: 10.1016/s0022-3476(88)80054-4.
To help shed some light on the 50-year-old controversy concerning the possible protective effect of breast feeding on subsequent atopic disease, I developed 12 standards pertaining to both biologic and methodologic aspects of exposure (infant feeding), outcome (atopic conditions), and statistical analysis for studies of atopic eczema, asthma, allergic rhinitis, cow milk allergy, and other food allergy. Among the published studies on atopic eczema, the nine claiming a protective benefit of breast feeding performed less well than the 12 not making such a claim on "methodologic" standards relating to strict diagnostic criteria and blind ascertainment of outcome. The positive studies were somewhat stronger, however, on the "biologic" standards bearing on sufficient duration and exclusivity of breast feeding and on separate analysis of children at high risk. For the other atopic conditions, there were no important differences between positive and negative studies. In few negative or positive studies was there adequate control for confounding variables or examination of potential benefits relating to the severity or age at onset of atopic disease. To avoid another 50 years of unresolved controversy, future studies should improve both the biologic and methodologic aspects of their design and analysis.
为了帮助阐明这场长达50年的争议，即母乳喂养对后续过敏性疾病可能具有的保护作用，我制定了12条标准，涉及暴露（婴儿喂养）、结局（过敏性疾病）的生物学和方法学方面，以及对特应性皮炎、哮喘、过敏性鼻炎、牛奶过敏和其他食物过敏研究的统计分析。在已发表的关于特应性皮炎的研究中，九项声称母乳喂养有保护作用的研究，在与严格诊断标准和结局的盲法确定相关的“方法学”标准方面，表现不如另外12项未作此声称的研究。然而，在关于母乳喂养的持续时间和排他性的“生物学”标准以及对高危儿童的单独分析方面，得出肯定结论的研究稍强一些。对于其他过敏性疾病，得出肯定和否定结论的研究之间没有重要差异。在少数得出否定或肯定结论的研究中，几乎没有对混杂变量进行充分控制，也没有考察与过敏性疾病的严重程度或发病年龄相关的潜在益处。为避免再出现50年无法解决的争议，未来的研究应在设计和分析的生物学和方法学方面都加以改进。
