Analgesic antipyretic use among young children in the TEDDY study: no association with islet autoimmunity.
Analgesic antipyretic use among young children in the TEDDY study: no association with islet autoimmunity.
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DOI：
10.1186/s12887-017-0884-y
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发表时间：
2017-05-16
期刊：
影响因子：
2.4
通讯作者：
TEDDY Study Group
中科院分区：
文献类型：
--
作者：
Lundgren M;Steed LJ;Tamura R;Jonsdottir B;Gesualdo P;Crouch C;Sjöberg M;Hansson G;Hagopian WA;Ziegler AG;Rewers MJ;Lernmark Å;Toppari J;She JX;Akolkar B;Krischer JP;Haller MJ;Elding Larsson H;TEDDY Study Group
儿童使用解热镇痛药（ANAP）长期以来一直是一个有争议的问题。然而，关于其在个体层面实际使用的数据却很匮乏。有迹象表明，使用ANAP可能对血糖稳态和免疫功能产生影响。本研究的目的是分析青少年糖尿病环境决定因素（TEDDY）前瞻性队列研究中各临床中心解热镇痛药的使用模式，并检验使用ANAP是否为胰岛自身免疫的一个风险因素。
收集了8542名儿童在生命最初2.5年的数据。使用以国家和是否为第一个孩子作为自变量的逻辑回归分析发病率。采用霍尔姆法对国家间比较的多重性进行调整。使用考克斯比例风险模型分析自身抗体血清转化时间，将累积的解热镇痛药使用情况作为主要的感兴趣的时间依赖性协变量。对于每一种分类，都采用了广义估计方程（GEE）方法。
与芬兰（78.1%）和德国（80.2%）相比，美国（95.7%）和瑞典（94.8%）使用ANAP的比例更高。第一个孩子更常使用对乙酰氨基酚（比值比1.26；95%置信区间1.07 - 1.49；p = 0.007），但较少使用非甾体抗炎药（NSAID）（比值比0.86；95%置信区间0.78 - 0.95；p = 0.002）。在无发热和感染的情况下使用对乙酰氨基酚和NSAID在美国更为普遍（40.4%；26.3%的剂量），与瑞典、芬兰和德国相比（p < 0.001）。
在2.5岁前使用对乙酰氨基酚或NSAID并不能预测到6岁时胰岛自身免疫的发生（风险比1.02，95%置信区间0.99 - 1.09；p = 0.27）。在一项亚分析中，发热儿童使用对乙酰氨基酚对3岁时胰岛自身免疫的发生有微弱的预测作用（风险比1.05；95%置信区间1.01 - 1.09；p = 0.024）。
幼儿使用ANAP不是到6岁时血清转化的风险因素。ANAP在幼儿中使用广泛，并且在美国比其他研究地点明显更高，在美国即使无发热和感染情况使用也很常见。
本文的网络版（doi:10.1186/s12887 - 017 - 0884 - y）包含补充材料，授权用户可获取。
The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm’s procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection. The online version of this article (doi:10.1186/s12887-017-0884-y) contains supplementary material, which is available to authorized users.