Broad-Spectrum Antibiotic Treatment and Subsequent Childhood Type 1 Diabetes: A Nationwide Danish Cohort Study.
Broad-Spectrum Antibiotic Treatment and Subsequent Childhood Type 1 Diabetes: A Nationwide Danish Cohort Study.
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广谱抗生素治疗与罹患 1 型糖尿病的儿童： 丹麦全国队列研究》。
DOI：
10.1371/journal.pone.0161654
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Løkkegaard EC
中科院分区：
文献类型：
--
作者：
Clausen TD;Bergholt T;Bouaziz O;Arpi M;Eriksson F;Rasmussen S;Keiding N;Løkkegaard EC
研究表明，抗生素治疗和剖腹产与肠道微生物群变化导致的慢性疾病风险增加有关。我们的目的是评估在出生后的头两年内使用广谱抗生素治疗与随后儿童1型糖尿病发病的关系，以及通过分娩方式改变的潜在效果。一项丹麦全国性队列研究，包括1997 - 2010年出生的所有独生子女。2012年12月结束后续行动。四个国家登记处提供了关于抗生素赎回、结局和混杂因素的信息。在生命的前两年，抗生素处方的赎回被分为窄谱或广谱抗生素。儿童从2岁到14岁（包括2岁和14岁）接受随访。通过考克斯回归分析评估15岁以前发病的1型糖尿病的风险。共有858，201名独生子女贡献了5，906，069人-年，其中1，503名儿童患上了1型糖尿病。在出生后的前2年内使用广谱抗生素与出生后13年内1型糖尿病的发生率增加相关（HR 1.13; 95%CI 1.02 - 1.25），然而，该发生率受分娩方式的影响。广谱抗生素与产时剖宫产（HR 1.70; 95%CI 1.15 - 2.51）或产前剖宫产（HR 1.63; 95%CI 1.11 - 2.39）分娩的儿童1型糖尿病发生率增加相关，但与阴道分娩的儿童无关。需要伤害的人数分别为433和562。与广谱抗生素的相关性不受产次、遗传易感性或母亲在妊娠或哺乳期间对抗生素的赎回的影响。婴儿期使用广谱抗生素与剖宫产分娩的儿童1型糖尿病风险增加相关。
Studies link antibiotic treatment and delivery by cesarean section with increased risk of chronic diseases through changes of the gut-microbiota. We aimed to evaluate the association of broad-spectrum antibiotic treatment during the first two years of life with subsequent onset of childhood type 1 diabetes and the potential effect-modification by mode of delivery. A Danish nationwide cohort study including all singletons born during 1997–2010. End of follow-up by December 2012. Four national registers provided information on antibiotic redemptions, outcome and confounders. Redemptions of antibiotic prescriptions during the first two years of life was classified into narrow-spectrum or broad-spectrum antibiotics. Children were followed from age two to fourteen, both inclusive. The risk of type 1 diabetes with onset before the age of 15 years was assessed by Cox regression. A total of 858,201 singletons contributed 5,906,069 person-years, during which 1,503 children developed type 1 diabetes. Redemption of broad-spectrum antibiotics during the first two years of life was associated with an increased rate of type 1 diabetes during the following 13 years of life (HR 1.13; 95% CI 1.02 to 1.25), however, the rate was modified by mode of delivery. Broad-spectrum antibiotics were associated with an increased rate of type 1 diabetes in children delivered by either intrapartum cesarean section (HR 1.70; 95% CI 1.15 to 2.51) or prelabor cesarean section (HR 1.63; 95% CI 1.11 to 2.39), but not in vaginally delivered children. Number needed to harm was 433 and 562, respectively. The association with broad-spectrum antibiotics was not modified by parity, genetic predisposition or maternal redemption of antibiotics during pregnancy or lactation. Redemption of broad-spectrum antibiotics during infancy is associated with an increased risk of childhood type 1 diabetes in children delivered by cesarean section.