The effect of past antibiotic exposure on diabetes risk.
The effect of past antibiotic exposure on diabetes risk.
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DOI：
10.1530/eje-14-1163
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发表时间：
2015-06
影响因子：
5.8
通讯作者：
Yang YX
中科院分区：
文献类型：
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作者：
Boursi B;Mamtani R;Haynes K;Yang YX
肠道微生物群影响与肥胖、胰岛素抵抗和糖尿病发病机制相关的代谢途径。抗生素治疗可以改变微生物群，在西方国家常用。我们试图评估过去的抗生素暴露是否会增加糖尿病风险。我们使用来自英国（UK）的大型基于人群的数据库进行了巢式病例对照研究。病例定义为有糖尿病偶发诊断的病例。对于每例病例，采用发病率密度抽样法选择4名年龄、性别、实习地点和随访时间相匹配的合格对照者。关注的暴露是索引日期前>1年的抗生素治疗。采用条件Logistic回归估计比值比（OR）和95%置信区间（CI）。调整了体重指数（BMI）、吸烟、末次血糖水平和索引日期前的感染次数以及既往冠状动脉疾病和高脂血症病史的风险。该研究包括208，002名糖尿病患者和815，576名匹配的对照。接触单一抗生素处方与较高的调整后糖尿病风险无关。青霉素类、头孢菌素类、大环内酯类和喹诺酮类抗生素治疗2-5个疗程与糖尿病风险增加相关，调整后OR范围为青霉素1.08（95%CI 1.05-1.11）至喹诺酮类1.15（95%CI 1.08-1.23）。随着抗生素疗程数的增加，风险增加，超过5个疗程的喹诺酮类药物的风险达到1.37（95%CI 1.19-1.58）。接触抗病毒药物和抗真菌药物与糖尿病风险之间没有关联。接触某些抗生素会增加糖尿病风险。
Gut microbiota influence metabolic pathways relevant to the pathogenesis of obesity, insulin-resistance and diabetes. Antibiotic therapy can alter the microbiota and is commonly used in western countries. We sought to evaluate whether past antibiotic exposure increases diabetes risk. We conducted a nested case-control study using a large population-based database from the United Kingdom (UK). Cases were defined as those with incident diagnosis of diabetes. For every case, 4 eligible controls matched on age, sex, practice-site, and duration of follow-up before index-date were selected using incidence-density sampling. Exposure of interest was antibiotic therapy >1 year before index-date. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. The risk was adjusted for body mass index (BMI), smoking, last glucose level and number of infections before index-date, as well as past medical history of coronary artery disease and hyperlipidemia. The study included 208,002 diabetic cases and 815,576 matched controls. Exposure to a single antibiotic prescription was not associated with higher adjusted diabetes risk. Treatment with 2–5 antibiotic courses was associated with increase in diabetic risk for penicillin, cephalosporins, macrolides and quinolones with adjusted OR ranging from 1.08 (95%CI 1.05–1.11) for penicillin to 1.15 (95%CI 1.08–1.23) for quinolones. The risk increased with the number of antibiotic courses and reached 1.37 (95%CI 1.19–1.58) for >5 courses of quinolones. There was no association between exposure to anti-virals and anti-fungals and diabetes risk. Exposure to certain antibiotic groups increases diabetes risk.