哮喘联盟

   摘要
   目的：研究局部和全身皮质类固醇激素宫内暴露是否与子代哮喘发生有关。
   设计：队列研究。
   地区：丹麦。
   受试者：纳入1996年-2009年丹麦出生的所有单胎产儿。母亲使用皮质类固醇及子代患哮喘的情况和协变量的数据都来自医疗注册信息。
   主要检查结果：比较皮质类固醇产前暴露儿童、曾使用皮质类固醇的儿童与正常儿童的哮喘风险。计算绝对风险因素，并采用比例-风险回归模型计算校正HRs（aHRs）。采用“同母异胎”分析比较暴露儿童和其非暴露的兄弟姐妹。根据随访时间进行校正。
   结果：共877778例儿童纳入研究，其中3.6%产前暴露于全身(n=5327)或局部(n=24 436)皮质类固醇。在随访过程中共105677例儿童患哮喘，暴露儿童和非暴露儿童的10年发病风险分别为18.4%和13.5%。产前全身暴露、产前局部暴露和曾使用皮质类固醇的aHR分别为1.54 (95% CI 1.45-1.65)、1.45 (95% CI 1.40-1.50)和1.32 (95% CI 1.30-1.34)。“同母异胎”分析后的校正OR为1.11 (95% 可信区间 0.98-1.25)。
   结论：这些基于人群的数据并不支持孕期皮质类固醇使用和子代哮喘风险增加间存在强因果关系。

 

（刘国梁 审校）
BMJ Open. 2014 Jun 5;4(6):e005053. doi: 10.1136/bmjopen-2014-005053.

 

Use of corticosteroids during pregnancy and risk of asthma in offspring: a nationwide Danish cohort study.
 

Byrjalsen A, Frøslev T, Telén Andersen AB, Olsen M, Sørensen HT.
 

ABSTRACT 
OBJECTIVE:To examine whether in utero exposure to local and systemic corticosteroids is associated with asthma development in offspring.
DESIGN: Cohort study.
SETTING: Denmark.
PARTICIPANTS: We included all singletons born alive in Denmark between 1996 and 2009. Data on maternal corticosteroid use, asthma in offspring and covariates were obtained from medical registries.
MAIN OUTCOME MEASURES: We compared asthma risks of children prenatally exposed to corticosteroids and of children of former corticosteroid users with that of unexposed children. We computed absolute risks and used proportional-hazards regression to compute adjusted HRs (aHRs). Using logistic regression we compared exposed children with unexposed siblings in a 'within-mother-between-pregnancy' analysis. Adjustment addressed varying length of follow-up.
RESULTS: We identified 877 778 children, 3.6% of whom were prenatally exposed to systemic (n=5327) or local (n=24 436) corticosteroids. A total of 105 677 children developed asthma during follow-up with a 10-year risk of 18.4% among the exposed and 13.5% among the unexposed. The aHR was 1.54 (95% CI 1.45 to 1.65) for systemic use, 1.45 (95% CI 1.40 to 1.50) for local use and 1.32 (95% CI 1.30 to 1.34) for former use. The adjusted OR of the 'within-mother-between-pregnancy' analysis was 1.11 (95% CI 0.98 to 1.25).
CONCLUSIONS: These population-based data do not support a strong causal association between maternal corticosteroid use during pregnancy and increased asthma risk in offspring.
 

BMJ Open. 2014 Jun 5;4(6):e005053. doi: 10.1136/bmjopen-2014-005053.