Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
College of Medicine, Jeonbuk National University, Jeonju, South Korea.
Thyroid. 2024 Jan;34(1):112-122. doi: 10.1089/thy.2023.0235. Epub 2023 Dec 18.
Although recent studies have introduced antibiotics as a potential risk factor for thyroid cancer, further studies are necessary. We examined the association between long-term antibiotic usage and thyroid cancer risk. This nationwide cohort study investigated 9,804,481 individuals aged 20 years or older who participated in health screening (2005-2006) with follow-up ending on December 31, 2019, using the Korean National Health Insurance Service database. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for thyroid cancer risk according to the cumulative days of antibiotic prescription and the number of antibiotic classes, respectively. A 1:1 propensity score (PS) matching was also performed for analysis. Compared with nonusers of antibiotics, participants prescribed ≥365 days of antibiotics showed an increased risk of thyroid cancer (aHR, 1.71; CI, 1.66-1.78) after adjusting for covariates including age, smoking status, comorbidities including thyroid-related diseases, and the number of head and neck computed tomography scans. Participants prescribed ≥365 days of antibiotics also had a significantly increased risk of thyroid cancer (aHR, 1.37; CI, 1.34-1.40) compared with participants prescribed 1-14 days of antibiotics. Association remained significant in the 1:1 PS-matched cohort. Moreover, compared with nonusers of antibiotics, the 5 or more antibiotic class user group had a higher thyroid cancer risk (aHR, 1.71; CI, 1.65-1.78). Long-term antibiotic prescriptions and an increasing number of antibiotic classes may be associated with a higher risk of thyroid cancer in a duration-dependent manner. The effects of long-term antibiotic exposure on thyroid cancer should be further investigated.
虽然最近的研究将抗生素作为甲状腺癌的一个潜在危险因素，但还需要进一步的研究。我们研究了长期使用抗生素与甲状腺癌风险之间的关系。这项全国性的队列研究调查了 9804481 名年龄在 20 岁或以上的参加健康筛查的个体（2005-2006 年），随访截止日期为 2019 年 12 月 31 日，使用了韩国国家健康保险服务数据库。使用多变量 Cox 比例风险回归来估计根据抗生素处方的累积天数和抗生素类别的数量，分别为甲状腺癌风险调整后的危险比（aHR）和 95%置信区间（CI）。还进行了 1:1 倾向评分（PS）匹配分析。与未使用抗生素的参与者相比，调整包括年龄、吸烟状况、包括甲状腺相关疾病在内的合并症以及头颈部计算机断层扫描次数在内的混杂因素后，处方≥365 天抗生素的参与者患甲状腺癌的风险增加（aHR，1.71；CI，1.66-1.78）。与处方 1-14 天抗生素的参与者相比，处方≥365 天抗生素的参与者患甲状腺癌的风险也显著增加（aHR，1.37；CI，1.34-1.40）。在 1:1 PS 匹配队列中，相关性仍然显著。此外，与未使用抗生素的参与者相比，使用 5 种或更多抗生素类别的参与者甲状腺癌风险更高（aHR，1.71；CI，1.65-1.78）。长期使用抗生素和使用抗生素类别的数量增加可能与甲状腺癌风险的增加呈时间依赖性相关。长期接触抗生素对甲状腺癌的影响应进一步研究。
