人乳喂养对哮喘、肺功能和支气管高反应性的作用
2010/01/07
关键词：哮喘；特应性；人乳喂养；支气管高反应性；儿童；国际儿童哮喘和过敏症研究
在国际儿童哮喘和过敏症研究（the International Study of Asthma and Allergy in Childhood, ISAAC）的第二阶段，Nagel等对人乳喂养对喘息、肺功能和特应性的作用进行了评估。
研究者对来自20个国家、27个分中心、54000例学龄期儿童（年龄：8～12岁）的数据进行交叉研究。通过父母问卷方式获取调查对象疾病和危险因素的资料，并对其中31759例儿童进行了皮肤针刺检查。在次级样本（4888例）进行肺功能和气道反应性测定，以分析喂养方式对支气管高反应性和肺功能的作用。
结果显示，无论发达国家或发展中国家，人乳喂养均能降低喘息的发生（发达国家OR：0.87, 95% CI：0.78–0.97；发展中国家OR：0.80, 95% CI：0.68–0.94)。进一步分析发现，人乳喂养只能减少发展中国家儿童非特应性喘息的发生(OR：0.69, 95% CI：0.53–0.90)，而与特应性喘息和过敏症无关。甚至在发达国家中，人乳喂养与儿童FEV1预测值升高有关(平均比率：1.11, 95% CI：1.02–1.20)。
根据研究结果，作者认为：在发展中国家中，人乳喂养能减少非特应性喘息的发生；但总体看来，人乳喂养过敏症的测定指标无关。本研究有助于解释一些有关人乳喂养和过敏症相关性的矛盾。
在国际儿童哮喘和过敏症研究（the International Study of Asthma and Allergy in Childhood, ISAAC）的第二阶段，Nagel等对人乳喂养对喘息、肺功能和特应性的作用进行了评估。
研究者对来自20个国家、27个分中心、54000例学龄期儿童（年龄：8～12岁）的数据进行交叉研究。通过父母问卷方式获取调查对象疾病和危险因素的资料，并对其中31759例儿童进行了皮肤针刺检查。在次级样本（4888例）进行肺功能和气道反应性测定，以分析喂养方式对支气管高反应性和肺功能的作用。
结果显示，无论发达国家或发展中国家，人乳喂养均能降低喘息的发生（发达国家OR：0.87, 95% CI：0.78–0.97；发展中国家OR：0.80, 95% CI：0.68–0.94)。进一步分析发现，人乳喂养只能减少发展中国家儿童非特应性喘息的发生(OR：0.69, 95% CI：0.53–0.90)，而与特应性喘息和过敏症无关。甚至在发达国家中，人乳喂养与儿童FEV1预测值升高有关(平均比率：1.11, 95% CI：1.02–1.20)。
根据研究结果，作者认为：在发展中国家中，人乳喂养能减少非特应性喘息的发生；但总体看来，人乳喂养过敏症的测定指标无关。本研究有助于解释一些有关人乳喂养和过敏症相关性的矛盾。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
(Eur Respir J 2009; 33:993-1002)
Effect of breastfeeding on asthma, lung function and bronchial hyperreactivity in ISAAC Phase II
G. Nagel, G. Büchele, G. Weinmayr, B. Björkstén, Y-Z. Chen, H. Wang, W. Nystad, Y. Saraclar, L. Bråbäck, J. Batlles-Garrido, G. Garcia-Hernandez, S. K. Weiland, 
and the ISAAC Phase II Study Group
Keywords: Asthma, atopy, breastfeeding, bronchial hyperreactivity, children, International Study of Asthma and Allergy in Childhood
and the ISAAC Phase II Study Group Keywords: Asthma, atopy, breastfeeding, bronchial hyperreactivity, children, International Study of Asthma and Allergy in Childhood
The association between breastfeeding and wheezing, lung function and atopy was evaluated in the International Study of Asthma and Allergy in Childhood (ISAAC) Phase II.
Cross-sectional studies were performed in 27 centres in 20 countries. Information on disease and exposure factors was collected by parental questionnaires. Data from 54,000 randomly selected school children (aged 8–12 yrs, 31,759 with skin prick testing) and a stratified subsample (n = 4,888) were used for testing the correlation of breastfeeding with bronchial hyperreactivity and lung function. Random effect models for meta-analysis were applied to calculate combined odds ratios (ORs).
Any breastfeeding was associated with less wheeze both in affluent (adjusted OR (ORadj) 0.87, 95% confidence interval (CI) 0.78–0.97) and nonaffluent countries (ORadj 0.80, 95% CI 0.68–0.94). Further analyses revealed that this was true only for non atopic wheeze in nonaffluent countries (ORadj 0.69, 95% CI 0.53–0.90). Breastfeeding was not associated with atopic wheeze and objective measures of allergy in both affluent and nonaffluent countries. In contrast, breastfeeding was associated with higher predicted forced expiratory volume in one second in affluent countries only (mean ratio 1.11, 95% CI 1.02–1.20).
Breastfeeding is associated with protection against nonatopic wheeze, which becomes particularly evident in nonaffluent countries. Overall, breastfeeding was not related to any measure of allergy. These findings may explain some of the controversy regarding breastfeeding, since the direction of the association with breastfeeding depends on the predominating wheeze phenotype (e.g. atopic, nonatopic).
Eur Respir J 2009; 33:993-1002
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对加利福尼亚州教师体重、腰围以及哮喘患病率的研究
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肥胖和TNFA变异性对哮喘的联合作用：两个国际队列研究
