Risk of childhood leukemia associated with vaccination, infection, and medication use in childhood
Risk of childhood leukemia associated with vaccination, infection, and medication use in childhood
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DOI：
10.1093/aje/kwm339
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发表时间：
2008-03-01
影响因子：
5
通讯作者：
Theriault, Gilles P.
中科院分区：
文献类型：
--
作者：
MacArthur, Amy C.;McBride, Mary L.;Theriault, Gilles P.
目前与儿童早期白血病发病率高峰相一致的假设表明，其病因是感染性的。作者研究了预计会影响早期免疫功能的产后暴露的影响，包括儿童疫苗接种、疾病、药物使用和母乳喂养模式。 1990 年至 1994 年间诊断患有白血病且居住在加拿大主要城市的 0-15 岁儿童有资格纳入。通过儿科肿瘤中心和人口癌症登记处，诊断时确定了 399 例病例。对于每个参与案例，从政府健康保险名册中随机选择年龄、性别和地区匹配的对照。风险因素信息是通过与每个孩子的父母或监护人进行个人访谈获得的。使用条件逻辑回归来计算优势比，并调整潜在的混杂因素。指标儿童使用免疫抑制剂导致风险不足（比值比 = 0.37，95% 置信区间：0.16，0.84），而维生素摄入量与白血病呈正相关（比值比 = 1.66，95% 置信区间：1.18，2.33）。母乳喂养超过 6 个月也具有保护作用（p < 0.05）。对于诊断为急性淋巴细胞白血病的病例和 1-5 岁诊断的儿童，结果仍然存在。这些发现表明早期免疫挑战在儿童白血病的表达中发挥作用。
Current hypotheses consonant with the peak in leukemia incidence in early childhood point to an infectious etiology. The authors examined the effect of postnatal exposures predicted to affect early immune functioning, including childhood vaccinations, illness, medication use, and breastfeeding patterns. Children 0-15 years of age diagnosed with leukemia from 1990 to 1994 and resident within principal cities across Canada were eligible for inclusion. Through pediatric oncology centers and population-based cancer registries, 399 cases were ascertained at the time of diagnosis. For each participating case, an age-, gender-, and area-matched control was randomly selected from government health insurance rolls. Risk factor information was obtained through personal interviews with each child's parents or guardians. Conditional logistic regression was used to calculate odds ratios, with adjustment for potential confounders. Use of immunosuppressant medication by the index child led to a deficit of risk (odds ratio = 0.37, 95% confidence interval: 0.16, 0.84), while vitamin intake was positively associated with leukemia (odds ratio = 1.66, 95% confidence interval: 1.18, 2.33). Breastfeeding for more than 6 months was also protective (p < 0.05). Results persisted for cases diagnosed with acute lymphoblastic leukemia and for children diagnosed at 1-5 years of age. These findings suggest a role for early immunologic challenge in the expression of childhood leukemia.