Ethnic difference in daycare attendance, early infections, and risk of childhood acute lymphoblastic leukemia
Ethnic difference in daycare attendance, early infections, and risk of childhood acute lymphoblastic leukemia
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DOI：
10.1158/1055-9965.epi-05-0115
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发表时间：
2005-08-01
影响因子：
3.8
通讯作者：
Wiencke, JK
中科院分区：
文献类型：
--
作者：
Ma, XM;Buffler, PA;Wiencke, JK
感染因子在儿童急性淋巴细胞白血病（ALL）病因学中的作用已经被提出，特别是对于常见的ALL （c-ALL；在2-5岁儿童中诊断并表达CD10和CD19表面抗原的ALL）。在北加州儿童白血病研究中，我们评估了日托出勤（暴露于感染性病原体的替代措施）和婴儿期感染可能的病因学作用。该分析共纳入294例ALL病例（年龄1-14岁）和376例单独匹配的对照。在非西班牙裔白人儿童中，以儿童小时数衡量的日托出勤率与ALL风险显著降低相关。与没有参加任何日托的儿童相比，婴儿期有5000个儿童小时的儿童ALL的优势比（OR）为0.42[95%可信区间（95% CI）， 0.18-0.99]， c-ALL的优势比为0.33 （95% Cl, 0.11-1.01）。趋势测试也很重要，这支持了剂量-反应关系。婴儿时期的日托服务与相同的儿童小时数相关的影响幅度比诊断前的日托服务更强。此外，在非西班牙裔白人儿童中，婴儿期自我报告的耳部感染与显著降低的c-ALL风险相关（OR, 0.32; 95% Cl, 0.14-0.74）。在西班牙裔儿童中，未观察到日托出勤率、早期感染和儿童ALL或c-ALL风险之间的关联。这些结果为非西班牙裔白人儿童ALL病因学的传染病假说提供了间接但有力的支持，并突出了重要的种族差异。
A role for infectious agents has been proposed in the etiology of childhood acute lymphoblastic leukemia (ALL), particularly for common ALL (c-ALL; ALL diagnosed in children ages 2-5 years and expressing CD10 and CD19 surface antigens). We evaluated the possible etiologic role of daycare attendance (a proxy measure for exposure to infectious agents) and infections during infancy in the Northern California Childhood Leukemia Study. A total of 294 incident ALL cases (ages 1-14 years) and 376 individually matched controls were included in this analysis. In non-Hispanic White children, daycare attendance measured by child-hours was associated with a significantly reduced risk of ALL. Compared with children who did not attend any daycare, the odds ratio (OR) for those who had > 5,000 child-hours during infancy was 0.42 [95% confidence interval (95% CI), 0.18-0.99] for ALL and 0.33 (95% Cl, 0.11-1.01) for c-ALL. Test for trend is also significant, which supports a dose-response relationship. The magnitude of effect associated with the same number of child-hours was stronger for daycare attendance during infancy than for daycare attendance before diagnosis. In addition, self-reported ear infection during infancy was associated with a significantly reduced risk of c-ALL (OR, 0.32; 95% Cl, 0.14-0.74) in non-Hispanic White children. In Hispanic children, no association was observed among daycare attendance, early infections, and risk of childhood ALL or c-ALL. These results offer indirect yet strong support for the infectious disease hypothesis in the etiology of ALL in non-Hispanic White children and highlight an important ethnic difference.