Childhood asthma after bacterial colonization of the airway in neonates
Childhood asthma after bacterial colonization of the airway in neonates
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DOI：
10.1056/nejmoa052632
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发表时间：
2007-10-11
影响因子：
158.5
通讯作者：
Pipper, Christian Bressen
中科院分区：
文献类型：
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作者：
Bisgaard, Hans;Hermansen, Mette Northman;Pipper, Christian Bressen
研究背景反复发作的严重喘鸣患儿的气道病理特征提示细菌定植与早期哮喘的起始事件有关。我们进行了一项研究，以调查无症状新生儿下咽部细菌定植与出生后5年内复发性喘息、哮喘和过敏的发展之间可能存在的联系。方法受试者是来自哥本哈根哮喘前瞻性研究的儿童儿童出生队列中母亲患有哮喘的儿童。从无症状的1个月大婴儿的下咽部吸出物进行肺炎链球菌、流感嗜血杆菌、卡他莫拉菌和金黄色葡萄球菌培养。在出生后的前5年，通过日记卡前瞻性监测喘息。在4岁时测量血嗜酸性粒细胞计数和总IgE及特异性IgE。肺功能测定和哮喘被诊断为在5岁。Results下咽样本培养从321名新生儿在1个月大。21%的婴儿被S. pneumoniae、M. catarrhalis、卡他莫拉菌H.流感，或这些微生物的组合;定植一种或多种这些微生物，但不定植S.金黄色葡萄球菌感染与持续性哮鸣音（风险比，2.40; 95%可信区间[CI]，1.45 - 3.99）、哮鸣音急性重度加重（风险比，2.99; 95% CI，1.66 - 5.39）和因哮鸣音住院治疗（风险比，3.85; 95% CI，1.90 - 7.79）显著相关。血嗜酸性粒细胞计数和总IgE在4岁时显着增加，在儿童与S。pneumoniae、M. catarrhalis、卡他莫拉菌H.流感，或这些生物的组合，但特异性IgE没有显着影响。哮喘的患病率和气道阻力的可逆性后，β（2）-激动剂给药在5岁时显着增加，在儿童与这些有机体的定植与这些定植的儿童相比，没有这样的定植（33%对10%和23%对18%，分别）。pneumoniae，H. influenzae或M.卡他病或这些微生物的组合在生命早期具有增加的反复喘息和哮喘的风险。
BackgroundPathological features of the airway in young children with severe recurrent wheeze suggest an association between bacterial colonization and the initiating events of early asthma. We conducted a study to investigate a possible association between bacterial colonization of the hypopharynx in asymptomatic neonates and later development of recurrent wheeze, asthma, and allergy during the first 5 years of life.MethodsThe subjects were children from the Copenhagen Prospective Study on Asthma in Childhood birth cohort who were born to mothers with asthma. Aspirates from the hypopharyngeal region of asymptomatic 1-month-old infants were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Wheeze was monitored prospectively on diary cards during the first 5 years of life. Blood eosinophil count and total IgE and specific IgE were measured at 4 years of age. Lung function was measured and asthma was diagnosed at 5 years of age.ResultsHypopharyngeal samples were cultured from 321 neonates at 1 month of age. Twenty-one percent of the infants were colonized with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms; colonization with one or more of these organisms, but not colonization with S. aureus, was significantly associated with persistent wheeze (hazard ratio, 2.40; 95% confidence interval [CI], 1.45 to 3.99), acute severe exacerbation of wheeze (hazard ratio, 2.99; 95% CI, 1.66 to 5.39), and hospitalization for wheeze (hazard ratio, 3.85; 95% CI, 1.90 to 7.79). Blood eosinophil counts and total IgE at 4 years of age were significantly increased in children colonized neonatally with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms, but specific IgE was not significantly affected. The prevalence of asthma and the reversibility of airway resistance after beta(2)-agonist administration at 5 years of age were significantly increased in the children colonized neonatally with these organisms as compared with the children without such colonization (33% vs. 10% and 23% vs. 18%, respectively).ConclusionsNeonates colonized in the hypopharyngeal region with S. pneumoniae, H. influenzae, or M. catarrhalis, or with a combination of these organisms, are at increased risk for recurrent wheeze and asthma early in life.