Zhang Zeyi, Wang Jingjing, Wang Haixia, Li Yizhang, Jia Yuanmin, Yi Mo, Chen Ou
School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, #44 West Wenhua Road, Jinan, 250012, China.
World Allergy Organ J. 2021 Dec 6;14(11):100607. doi: 10.1016/j.waojou.2021.100607. eCollection 2021 Nov.
Infant antibiotic exposure may be associated with childhood asthma development.
To examine and detail this association considering potential confounders.
PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for publications from January 2011 to March 2021. Eligible studies were independently reviewed to extract data and assess quality. Random effect model was used to pool odds ratio (OR) and corresponding 95% confidence intervals (CIs).
A total of 52 studies were included. The association of infant antibiotic exposure and childhood asthma was statistically significant for overall analysis (OR, 1.37; 95% CI, 1.29-1.45) and for studies that addressed reverse causation (RC) and confounding by indication (CbI) (1.19; 95% CI, 1.11-1.28). Significance remained after stratification by adjustment for maternal antibiotic exposure, medical consultation, sex, smoke exposure, parental allergy, birth weight, and delivery mode. In detailed analyses, macrolides (OR, 1.56; 95% CI, 1.31-1.86), antibiotic course≥5 (OR, 1.79; 95% CI, 1.36-2.36), exposure within 1 week of birth (OR, 1.82; 95% CI, 1.34-2.47), asthma developed among 1-3 years (OR, 1.84; 95% CI, 1.63-2.08), short time lag between exposure and asthma onset (OR, 2.05; 95% CI, 1.91-2.20), persistent asthma (OR, 2.61; 95% CI, 1.49-4.59), and atopic asthma (OR, 2.14; 95% CI, 1.58-2.90) showed higher pooled estimates.
Infant antibiotic exposure is associated with increased risk of childhood asthma considering confounding, and the association varied with different settings of exposure and outcomes. This highlights the need for prevention of asthma after early antibiotic exposure. Heterogeneity among studies called for caution when interpretation.
婴儿期接触抗生素可能与儿童哮喘的发生有关。
考虑潜在混杂因素来研究并详细阐述这种关联。
检索了PubMed、EMBASE、科学网和考克兰图书馆2011年1月至2021年3月期间的出版物。对符合条件的研究进行独立评审以提取数据并评估质量。采用随机效应模型汇总比值比（OR）及相应的95%置信区间（CI）。
共纳入52项研究。婴儿期接触抗生素与儿童哮喘之间的关联在总体分析中具有统计学意义（OR = 1.37；95% CI：1.29 - 1.45），在处理反向因果关系（RC）和指征性混杂（CbI）的研究中也具有统计学意义（1.19；95% CI：1.11 - 1.28）。在对母亲抗生素接触、就医咨询、性别、烟雾暴露、父母过敏、出生体重和分娩方式进行调整分层后，这种关联仍然显著。在详细分析中，大环内酯类药物（OR = 1.56；95% CI：1.31 - 1.86）、抗生素疗程≥5天（OR = 1.79；95% CI：1.36 - 2.36）、出生后1周内接触（OR = 1.82；95% CI：1.34 - 2.47）、1 - 3岁时发生哮喘（OR = 1.84；95% CI：1.63 - 2.08）、接触与哮喘发作之间的时间间隔短（OR = 2.05；95% CI：1.91 - 2.20）、持续性哮喘（OR = 2.61；95% CI：1.49 - 4.59）和特应性哮喘（OR = 2.14；95% CI：1.58 - 2.90）的汇总估计值更高。
考虑到混杂因素，婴儿期接触抗生素与儿童哮喘风险增加有关，且这种关联因接触情况和结局的不同而有所差异。这凸显了在早期抗生素接触后预防哮喘的必要性。研究之间的异质性要求在解释时谨慎对待。
