Day care in infancy and risk of childhood acute lymphoblastic leukaemia: findings from UK case-control study
Day care in infancy and risk of childhood acute lymphoblastic leukaemia: findings from UK case-control study
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DOI：
10.1136/bmj.38428.521042.8f
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发表时间：
2005-06-04
影响因子：
105.7
通讯作者：
Alexander, FE
中科院分区：
文献类型：
--
作者：
Gilham, C;Peto, J;Alexander, FE
目的验证出生第一年接触常见感染会增加患急性淋巴细胞性白血病风险的假设。设计和设置英国儿童癌症研究(UKCCS)是一项基于大人群的儿童癌症病例对照研究，涉及英国10个地区。参与者6305名2-14岁非癌症儿童；3140例癌症儿童(1991年至2006年确诊)，其中1286例为急性淋巴细胞性白血病(ALL)。主要结局指标：日托和1岁时的社会活动作为婴儿期潜在感染风险的指标。结果社会活动水平的增加与ALL风险的持续降低相关，呈剂量-反应趋势。当母亲报告没有定期外出活动的儿童作为参照组时，任何社会活动增加活动水平的优势比为0.73(95%可信区间为0.62至0.87)，定期户外日托为0.62(0.51至0.75)，正规日托(至少每周两次有四个孩子的设施)为0.48(0.37至0.62)(Trend<；0.001的P值)。虽然不那么引人注目，但非所有恶性肿瘤的结果显示出类似的模式(趋势与趋势0.001的P值)。以非ALL恶性肿瘤儿童为参照组，只有正规日托对ALL有明显的保护作用(优势比=0.69，0.51~0.93；P=0.02)。在B细胞前体常见ALL和其他亚群以及5岁以上和5岁以下确诊的病例中也得到了类似的结果。结论这些结果支持这样的假设，即出生前几个月接触感染的次数减少会增加发生急性淋巴细胞白血病的风险。
Objective To test the hypothesis that reduced exposure to common infections in the first year of life increases the risk of developing acute lymphoblastic leukaemia.Design and setting The United Kingdom childhood cancer study (UKCCS) is a large population based case-control study of childhood cancer across 10 regions of the UK.Participants 6305 children (aged 2-14 years) without cancer; 3140 children with cancer (diagnosed 1991-6), of whom 1286 had acute lymphoblastic leukaemia (ALL).Main outcome measure Day care and social activity during the first year of life were used as proxies for potential exposure to infection in infancy..Results Increasing levels of social activity were associated with consistent reductions in risk of ALL; a dose-response trend was seen. When children whose mothers reported no regular activity outside the family were used as the reference group, odds ratios for increasing levels of activity were 0.73 (95% confidence interval 0.62 to 0.87) for any social activity, 0.62 (0.51 to 0.75) for regular day care outside the home, and 0.48 (0.37 to 0.62) for formal day care (attendance at facility with at least four children at least twice a week) (P value for trend < 0.001). Although not as striking, results for non-ALL malignancies showed a similar pattern (P value for trend < 0.001). When children with non-ALL malignancies were taken as the reference group, a significant protective effect for ALL was seen only for formal day care (odds ratio = 0.69, 0.51 to 0.93; P = 0.02). Similar results were obtained for B cell precursor common ALL and other subgroups, as well as for cases diagnosed above and below age 5 years.Conclusion These results support the hypothesis that reduced exposure to infection in the first few months of life increases the risk of developing acute lymphoblastic leukaemia.