目的 分析新生儿坏死性小肠结肠炎(NEC)后发生过敏性疾病的相关因素,为临床诊治提供参考依据。方法 2014年1月1日—12月31日对在重庆医科大学附属儿童医院初诊的137例NEC患儿进行3年随访,调查过敏性疾病的发生情况,并进行继发过敏性疾病危险因素的多因素Logistic回归分析。结果 137例NEC患儿中50例(36.5%)发生过敏性疾病。多因素Logistic回归分析显示,被动吸烟(OR=2.833,95%CI:1.066~7.532)、直系亲属过敏史(OR=4.637,95%CI:1.652~13.013)为NEC患儿发生过敏性疾病的独立危险因素(P＜0.05);而母乳喂养(OR=0.152,95%CI:0.042~0.547)、大便隐血阳性(OR=0.338,95%CI:0.141~0.811)为其保护因素(P＜0.05)。结论 NEC后过敏性疾病与较多因素有关,其中被动吸烟与直系亲属过敏史可增加NEC后过敏性疾病的发生率,需尽量避免和预防,提倡母乳喂养是减少过敏性疾病发生的有效手段。
Abstract
Objective To investigate the correlated factors for allergic disease secondary to necrotizing enterocolitis (NEC) in newborns,in order to provide evidence for clinical diagnosis and treatment. Methods The clinical data of 137 neonates with NEC from 1st January to 31st December,2014 were analyzed and followed-up for three years. The related factors for secondary allergic disease were evaluated by Logistic regression analysis. Results The rate of anaphylactic disease was 36.50% (50/137) after three-year follow-up. Multivariate Logistic regression analysis showed that second-hand smoking(OR=2.833,95%CI:1.066-7.532) and family history of allergy(OR=4.637,95%CI:1.652-13.013) were the independent risk factors of allergic disease in NEC children (P＜0.05),while breastfeeding(OR=0.152,95%CI:0.042-0.547) for at least first 4 months,positive result of fecal occult blood (OR=0.338,95%CI:0.141-0.811) were associated with lower incidence of allergic disease. Conclusions Allergic diseases after NEC are related to many factors. Second-hand smoking and family history of allergy increase the incidence of NEC,so these factors should be avoided. Meantime,breastfeeding is an effective means to reduce the occurrence of allergic diseases that is supposed to be encouraged.
关键词
新生儿坏死性小肠结肠炎 /
过敏性疾病 /
儿童
Key words
necrotizing enterocolitis /
allergic disease /
children
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Henriksen L,Simonsen J,Haerskjold A,et al. Incidence rates of atopic dermatitis,asthma,and allergic rhinoconjunctivitis in Danish and Swedish children[J].J Allergy Clin Immun,2015,136(2):360-366.
[2] Asher MI,Montefort S,Bjorksten B,et al. Worldwide time trends in the prevalence of symptoms of asthma,allergic rhinoconjunctivitis,and eczema in childhood:ISAAC Phases One and Three repeat multicountry cross-sectional surveys[J].Lancet,2006,368(9537):733-743.
[3] Koenig JE,Spor A,Scalfone N,et al. Succession of microbial consortia in the developing infant gut microbiome[J].Pnatl Acad Sci USA,2011,108(Suppl 1):4578-4585.
[4] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:477-483.
[5] 中华医学会变态反应学分会儿童过敏和哮喘学组,中华医学会儿科学分会呼吸学组哮喘协作组.抗组胺H1受体药在儿童常见过敏性疾病中应用的专家共识[J].中国实用儿科杂志,2018,33(3):161-170.
[6] 黄穗,王金华,黄顺开,等.广州市儿童变应性疾病流行病学调查分析[J].实用儿科临床杂志,2011,26(21):1629-1631.
[7] Georas SN,Rezaee F. Epithelial barrier function:at the front line of asthma immunology and allergic airway inflammation[J].J Allergy Clin Immun,2014,134(3):509-520.
[8] Cassir N,Simeoni U,La Scola B. Gut microbiota and the pathogenesis of necrotizing enterocolitis in preterm neonates[J].Future Microbiol,2016,11(2):273-292.
[9] Koplin JJ,Allen KJ,Gurrin LC,et al. The impact of family history of allergy on risk of food allergy:a population-based study of infants[J].Inter J Env Res Pub Heal,2013,10(11):5364-5377.
[10] Holbreich M,Genuneit J,Weber J,et al. Amish children living in northern Indiana have a very low prevalence of allergic sensitization[J].J Allergy Clin Immun,2012,129(6):1671-1673.
[11] Burke H,Leonardi-Bee J,Hashim A,et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze:systematic review and meta-analysis[J].Pediatrics,2012,129(4):735-744.
[12] Saulyte J,Regueira C,Montes-Martinez A,et al. Active or passive exposure to tobacco smoking and allergic rhinitis,allergic dermatitis,and food allergy in adults and children:a systematic review and meta-analysis[J].Plos Med,2014,11(3):e1001611.
[13] Orivuori L,Loss G,Roduit C,et al. Soluble immunoglobulin A in breast milk is inversely associated with atopic dermatitis at early age:the PASTURE cohort study[J].Clin Exp Allergy,2014,44(1):102-112.
[14] Dogaru CM,Nyffenegger D,Pescatore AM,et al. Breastfeeding and childhood asthma:systematic review and meta-analysis[J].Am J Epidemiol,2014,179(10):1153-1167.
[15] Muraro A,Dreborg S,Halken S,et al. Dietary prevention of allergic diseases in infants and small children. Part III:critical review of published peer-reviewed observational and interventional studies and final recommendations[J].Pediatr Allergy Immu,2004,15(4):291-307.
[16] Lodge CJ,Tan DJ,Lau MX,et al. Breastfeeding and asthma and allergies:a systematic review and Meta-analysis[J].Acta Paediatr,2015,104(467):38-53.
[17] Cilieborg MS,Boye M,Sangild PT. Bacterial colonization and gut development in preterm neonates[J].Early Hum Dev,2012,88(Suppl 1):41-49.
[18] Storro O,Avershina E,Rudi K. Diversity of intestinal microbiota in infancy and the risk of allergic disease in childhood[J].Curr Opin Allergy Cl,2013,13(3):257-262.
[19] Houghteling PD,Walker WA. From birth to "immunohealth", allergies and enterocolitis[J].J Clin Gastroenterol,2015,49(Suppl 1):7-12.
[20] Mihatsch WA,Braegger CP,Decsi T,et al. Critical systematic review of the level of evidence for routine use of probiotics for reduction of mortality and prevention of necrotizing enterocolitis and sepsis in preterm infants[J].Clin Nutr,2012,31(1):6-15.
[21] Tobin J,Ubergang J,Jacobs S,et al. Probiotics for the prevention of allergic diseases in very preterm infants[J]. J Paediatr Child Health,2016,52:56.
[22] Bertelsen RJ,Brantsaeter AL,Magnus MC,et al. Probiotic milk consumption in pregnancy and infancy and subsequent childhood allergic diseases[J].J Allergy Clin Immun,2014,133(1):165-171.
PDF(592 KB)
