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JACI:上海交大万燕萍研究组揭示孕期适补维D可减少儿童哮喘发生

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摘要 : 日前,世界著名期刊《The Journal of Allergy and Clinical Immunology》在线发表了上海交通大学医学院附属仁济医院临床营养科万燕萍主任题为《In utero exposure to 25(OH) D and risk of childhood asthma, wheeze and respiratory tract infections: a meta-analysis of birth cohort studies》的研究论文。

日前,世界著名期刊《The Journal of Allergy and Clinical Immunology》在线发表了上海交通大学医学院附属仁济医院临床营养科万燕萍主任题为《In utero exposure to 25(OH) D and risk of childhood asthma, wheeze and respiratory tract infections: a meta-analysis of birth cohort studies》的研究论文。硕士研究生冯海霞位论文第一作者,万燕萍研究员为论文通讯作者。

哮喘是常见的慢性呼吸道疾病,可引起反复发作性喘息、气急、胸闷或咳嗽等症状。全球约有3亿患者,我国哮喘患者人数超过1500万。2013年根据我国儿科哮喘协作组对全国14岁以下儿童的调查结果,在我国城市地区总患病率高达3.02%。众所周知,哮喘作为一种以可逆性气道阻塞、喘息、气道高反应及慢性炎症为特征的疾病,目前在全世界范围内流行,且通常儿童期开始发病。有大量研究证明母亲维生素D水平与子代儿童期哮喘相关,但众多研究结果不完全一致;研究同时提示哮喘与呼吸道感染之间存在密切关联。万燕萍-何卡研究组在经过对相关文章严格质量评价,并荟萃16篇前瞻性出生队列研究,这些研究均以母孕期外周血或脐血维生素D水平为暴露因素,研究事件终点为儿童期哮喘、喘息或呼吸道感染的发作,研究小组通过进行复杂的异质性分析、分层分析、敏感性分析,合理权重估算,随机效应模型的选择,结果显示母亲孕期维生素D水平的高低与子代发生哮喘或喘息呈负相关关系,此研究结果与近期两篇高质量的针对孕期补充维生素D的临床随机对照试验结果一致,更具有说服力。此外,该研究成果的一些数据,经过原文章作者另行计算补充,为本研究提供了新的珍贵数据,因而结果更为可靠。

万燕萍主任表示,维生素D是一种价廉且易获取的营养素,可能对人类生命早期编程及后续炎症调控有深远意义,因此重视母孕期维生素D的合理补充及定期监测,具有很深的临床及社会价值。

原文链接:

In utero exposure to 25(OH) D and risk of childhood asthma, wheeze and respiratory tract infections: a meta-analysis of birth cohort studies

原文摘要:

BackgroundStudies of the associations between in utero 25-hydroxyvitamin D [25(OH) D] exposure and childhood asthma risk, wheeze and respiratory tract infections are inconsistent and inconclusive.

ObjectivesTo assess the associations between 25(OH) D levels in cord blood or mateRNAl venous blood and risk of offspring’s asthma, wheeze and respiratory tract infections.

MethodsData were derived from PubMed, EMBASE, Google Scholar, references from relevant articles, and de novoresults from published studies until December, 2015. Random-effects meta-analysis was conducted among 16 birth cohort studies.

ResultsComparing the highest to the lowest category of 25 (OH) D levels, the pooled ORs were 0.84 (95% CI, 0.70 to 1.01; P = 0.064) for asthma, 0.77 (0.58 to 1.03; P = 0.083) for wheeze, and 0.85 (0.66 to 1.09; P = 0.187) for respiratory tract infections. The observed inverse association for wheeze was more pronounced and became statistically significant in the studies that measured 25 (OH) D levels in cord blood (0.43, 0.29 to 0.62; P < 0.001).

ConclusionsAccumulated evidence genErated from this meta-analysis suggests that increased in utero exposure to 25 (OH) D is inversely associated with the risk of asthma and wheeze during childhood. These findings are in keeping with the results of two recently published randomized clinical trials of vitamin D supplementation during pregnancy.

doi:10.1016/j.jaci.2016.06.065

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