Risk factors for atopic dermatitis in New Zealand children at 3.5 years of age
Risk factors for atopic dermatitis in New Zealand children at 3.5 years of age
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DOI：
10.1111/j.1365-2133.2005.06540.x
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发表时间：
2005-04-01
影响因子：
10.3
通讯作者：
Mitchell, EA
中科院分区：
文献类型：
--
作者：
Purvis, DJ;Thompson, JMD;Mitchell, EA
背景
在西方社会，特应性皮炎（AD）的患病率正在上升。卫生假说提出，这是由于生命早期接触环境过敏原和感染减少所致。
目的
研究与3.5岁时被诊断为AD相关的因素，特别是卫生假说所涉及的那些因素。
方法
奥克兰出生体重协作研究是一项针对小于胎龄儿危险因素的病例对照研究。病例为足月出生且出生体重＜第10百分位的婴儿。婴儿在出生时、1岁和3.5岁时接受评估。通过家长访谈和对儿童的检查收集数据。AD定义为在过去12个月内存在瘙痒性皮疹，且具备以下三项或更多项特征：屈侧受累病史；全身皮肤干燥病史；父母或兄弟姐妹有特应性疾病病史；以及按照摄影方案可见的屈侧性皮炎。统计分析考虑了研究人群的不均衡抽样。
结果
分析仅限于欧洲裔受试者。871名儿童在出生时入组，744名（85.4%）在1岁时参与研究，550名（63.2%）在3.5岁时参与研究。在3.5岁时见到的儿童中有87名（15.8%）被诊断为AD。AD的患病率不因出生体重而异。3.5岁时的AD与血清IgE升高＞200 kU/L以及1岁时的喘息、哮喘、皮疹或湿疹相关。在多变量分析中，在校正父母特应性和母乳喂养情况后，3.5岁时的AD与父母的特应性疾病相关：仅母亲有特应性，校正比值比（OR）为3.83，95%置信区间（CI）为1.20 - 12.23；仅父亲有特应性，校正OR为3.59，95%CI为1.09 - 11.75；父母双方都有特应性，校正OR为6.12，95%CI为2.02 - 18.50。母乳喂养持续时间越长，AD的风险越高：＜6个月，校正OR为6.13，95%CI为1.45 - 25.86；≥6个月，校正OR为9.70，95%CI为2.47 - 38.15，与从未母乳喂养相比。在调整环境因素和个人特应性病史后，这些发现仍然显著。3.5岁时的AD与3.5岁时养猫相关（校正OR为0.45，95%CI为0.21 - 0.97），但与3.5岁时养狗、1岁时养宠物以及有哥哥姐姐无关。此外，3.5岁时的AD与性别、社会经济地位、母亲吸烟、产次、潮湿、霉菌、免疫接种、体重指数或生命第一年使用抗生素无关。
结论
个人和父母的特应性疾病病史是3.5岁时患AD的危险因素。母乳喂养持续时间与AD风险增加相关。未发现与卫生假说所涉及的因素有关联。这项研究表明，不应推荐母乳喂养用于预防AD。
Background The prevalence of atopic dermatitis (AD) is increasing in Western societies. The hygiene hypothesis proposes that this is due to reduced exposure to environmental allergens and infections during early life.Objectives To examine factors associated with a diagnosis of AD at 3.5 years of age, especially those factors implicated by the hygiene hypothesis.Methods The Auckland Birthweight Collaborative study is a case-control study of risk factors for small for gestational age babies. Cases were born at term with birthweight 10th centile. The infants were assessed at birth, 1 year and 3.5 years of age. Data were collected by parental interview and examination of the child. AD was defined as the presence of an itchy rash in the past 12 months with three or more of the following: history of flexural involvement; history of generally dry skin; history of atopic disease in parents or siblings; and visible flexural dermatitis as per photographic protocol. Statistical analyses took into account the disproportionate sampling of the study population.Results Analysis was restricted to European subjects. Eight hundred and seventy-one children were enrolled at birth, 744 (85.4%) participated at 1 year, and 550 (63.2%) at 3.5 years. AD was diagnosed in 87 (15.8%) children seen at 3.5 years. The prevalence of AD did not differ by birthweight. AD at 3.5 years was associated with raised serum IgE > 200 kU L-1, and wheezing, asthma, rash or eczema at 1 year. In multivariate analysis, adjusted for parental atopy and breastfeeding, AD at 3.5 years was associated with atopic disease in the parents: maternal atopy only, adjusted odds ratio (OR) 3.83, 95% confidence interval (CI) 1.20-12.23; paternal atopy only, adjusted OR 3.59, 95% CI 1.09-11.75; both parents atopic, adjusted OR 6.12, 95% CI 2.02-18.50. There was a higher risk of AD with longer duration of breastfeeding: < 6 months, adjusted OR 6.13, 95% CI 1.45-25.86; >= 6 months, adjusted OR 9.70, 95% CI 2.47-38.15 compared with never breastfed. These findings remained significant after adjusting for environmental factors and a personal history of atopy. AD at 3.5 years was associated with owning a cat at 3.5 years (adjusted OR 0.45, 95% CI 0.21-0.97) but not with owning a dog at 3.5 years, pets at 1 year, nor with older siblings. Furthermore, AD at 3.5 years was not associated with gender, socioeconomic status, maternal smoking, parity, damp, mould, immunizations, body mass index or antibiotic use in first year of life.Conclusions A personal and a parental history of atopic disease are risk factors for AD at 3.5 years. Duration of breastfeeding was associated with an increased risk of AD. No association was found with those factors implicated by the hygiene hypothesis. This study suggests that breastfeeding should not be recommended for the prevention of AD.