Lisik Daniil, Ermis Saliha Selin Özuygur, Ioannidou Athina, Milani Gregorio Paolo, Nyassi Sungkutu, Spolidoro Giulia Carla Immacolata, Kankaanranta Hannu, Goksör Emma, Wennergren Göran, Nwaru Bright Ibeabughichi
Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Medicinaregatan 1F, 413 90, Göteborg, Sweden.
Department of Respiratory Medicine, Dokuz Eylul University, Izmir, Turkey.
World J Pediatr. 2023 Dec;19(12):1127-1138. doi: 10.1007/s12519-023-00706-w. Epub 2023 Mar 30.
Following the "hygiene hypothesis", the role of sibship composition in asthma and wheezing has been extensively studied, but the findings are inconsistent. For the first time, this systematic review and meta-analysis synthesized evidences from studies investigating the association of sibship size and birth order with risk of asthma and wheezing.
Fifteen databases were searched to identify eligible studies. Study selection and data extraction were performed independently by pairs of reviewers. Meta-analysis with robust variance estimation (RVE) was used to produce pooled risk ratio (RR) effect estimates from comparable numerical data.
From 17,466 identified records, 158 reports of 134 studies (> 3 million subjects) were included. Any wheezing in the last ≤ 1.5 years occurred more frequently in infants with ≥ 1 sibling [pooled RR 1.10, 95% confidence interval (CI) 1.02-1.19] and ≥ 1 older sibling (pooled RR 1.16, 95% CI 1.04-1.29). The pooled effect sizes for asthma were overall statistically nonsignificant, although having ≥ 1 older sibling was marginally protective for subjects aged ≥ 6 years (pooled RR 0.93, 95% CI 0.88-0.99). The effect estimates weakened in studies published after 2000 compared with earlier studies.
Being second-born or later and having at least one sibling is associated with a slightly increased risk of temporary wheezing in infancy. In contrast, being second-born or later is associated with marginal protection against asthma. These associations appear to have weakened since the turn of the millennium, possibly due to lifestyle changes and socioeconomic development. Video Abstract.
基于“卫生假说”，同胞构成在哮喘和喘息中的作用已得到广泛研究，但结果并不一致。本系统评价和荟萃分析首次综合了有关同胞数量和出生顺序与哮喘及喘息风险关联的研究证据。
检索了15个数据库以识别符合条件的研究。研究筛选和数据提取由成对的评审员独立进行。采用稳健方差估计（RVE）的荟萃分析从可比的数值数据中得出合并风险比（RR）效应估计值。
从17466条识别记录中，纳入了134项研究（超过300万受试者）的158份报告。在过去≤1.5年中，有≥1个兄弟姐妹的婴儿出现任何喘息的频率更高[合并RR 1.10，95%置信区间（CI）1.02 - 1.19]，有≥1个哥哥姐姐的婴儿也是如此（合并RR 1.16，95%CI 1.04 - 1.29）。哮喘的合并效应量总体上无统计学意义，尽管有≥1个哥哥姐姐对≥6岁的受试者有一定的保护作用（合并RR 0.93，95%CI 0.88 - 0.99）。与早期研究相比，2000年后发表的研究中效应估计值有所减弱。
排行老二及以后出生且至少有一个兄弟姐妹与婴儿期短暂喘息风险略有增加相关。相比之下，排行老二及以后出生与预防哮喘的边际保护作用相关。自千禧年之交以来，这些关联似乎有所减弱，可能是由于生活方式的改变和社会经济的发展。视频摘要。
