原標(biāo)題：剖腹產(chǎn)與兒童特應(yīng)性皮炎的風(fēng)險(xiǎn)
背景：剖腹產(chǎn)可能會(huì)破壞母嬰微生物的轉(zhuǎn)移，并改變免疫系統(tǒng)的發(fā)育以及隨后發(fā)生特應(yīng)性皮炎的風(fēng)險(xiǎn)。 
方法：母嬰信息是通過(guò)美國(guó)凱撒健康計(jì)劃和醫(yī)療集團(tuán)（KPNC）集成醫(yī)療系統(tǒng)收集的。數(shù)據(jù)來(lái)源包括電子醫(yī)療記錄、藥房數(shù)據(jù)庫(kù)、州出生記錄和前瞻性收集的母乳喂養(yǎng)調(diào)查。如果兒童在2005年至2014年之間出生于KPNC或其承包醫(yī)院并且連續(xù)至少四年入選KPNC的系統(tǒng)，則符合資格（n = 173105）。
結(jié)果：盡管未經(jīng)校正的分析顯示，剖腹產(chǎn)與特應(yīng)性皮炎之間存在正相關(guān)性[RR（95%CI）：1.06（1.03，1.10）]，但這種影響在校正后減弱為零[aRR（95%CI）：1.02（0.99），1.05）]。在分層分析中，有證據(jù)表明，剖腹產(chǎn)在某些亞組（例如，第一胎，BMI超重/肥胖的孕婦）中增加了特應(yīng)性皮炎的風(fēng)險(xiǎn)，但關(guān)聯(lián)性較弱。剖腹產(chǎn)分娩條件表明與母體微生物組的接觸最少（膜破裂和分娩之間的間隔很短），但沒有證據(jù)表明與這與特應(yīng)性皮炎有關(guān)。估計(jì)的相關(guān)性并沒有受到產(chǎn)時(shí)抗生素、母乳喂養(yǎng)、缺失數(shù)據(jù)或家庭因素的強(qiáng)烈影響。
結(jié)論：在這個(gè)大型的美國(guó)隊(duì)列中，剖腹產(chǎn)與兒童4歲時(shí)的特應(yīng)性皮炎無(wú)關(guān)。這種關(guān)聯(lián)似乎沒有受到產(chǎn)時(shí)抗生素、母乳喂養(yǎng)行為、剖腹產(chǎn)指征、缺失協(xié)變量或家族因素的影響。
延伸閱讀
Clinical & Experimental Allergy                                              
Caesarean delivery and the risk of atopic dermatitis in children
DOI: org/10.1111/cea.13668
Abstract:
Background: Caesarean delivery (C‐section) may disrupt maternal‐infant microbial transfer and alter immune system development and subsequent risk for atopic dermatitis.
Methods: P
Maternal and child information was collected through Kaiser Permanente Northern California's (KPNC) integrated healthcare system. Data sources included electronic medical records, pharmacy databases, state birth records, and prospectively collected breastfeeding surveys. Children were eligible if they were born in a KPNC or contracting hospital between 2005 and 2014 and had continuous enrolment in the KPNC system for at least four years (n=173105). Modified Poisson regression with robust variance estimation was used to estimate the association between C‐section and atopic dermatitis overall and when stratified by demographic and labour and delivery characteristics.
Results: Although unadjusted analyses showed a positive association between C‐section and atopic dermatitis [RR(95%CI): 1.06(1.03, 1.10)], this effect was attenuated towards the null after adjustment [aRR(95%CI): 1.02(0.99, 1.05)]. In stratified analyses, there was evidence that C‐section increased atopic dermatitis risk among certain subgroups (eg firstborns, overweight/obese pre‐pregnancy BMI), but associations were weak. C‐section delivery conditions indicative of the least exposure to maternal microbiome (ie no labour, short interval between membrane rupture and delivery) showed no evidence of association with atopic dermatitis. Estimated associations were not strongly influenced by intrapartum antibiotics, breastfeeding, missing data, or familial factors.
Conclusion: Caesarean delivery was not associated with atopic dermatitis by age four in this large US cohort. This association did not appear to be biased by intrapartum antibiotics, breastfeeding behaviour, C‐section indication, missing covariates, or familial factors.
First Author:
Megan Richards
Correspondence:
Megan Richards, School of Community Health Sciences 1664 N Virginia St, m/s 0275, Reno, NV 89557, USA.
All Authors:
Megan Richards, Jeannette Ferber, Hong Chen, Erin Swor, Charles P. Quesenberry, De‐Kun Li, Lyndsey A. Darrow
　　創(chuàng)建過(guò)敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過(guò)敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。