本文選題：病例對(duì)照 + 哮喘�。� 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)對(duì)前瞻性隊(duì)列研究進(jìn)行Meta分析,得到相關(guān)的循證醫(yī)學(xué)證據(jù),來(lái)評(píng)估1歲以前使用抗生素與兒童時(shí)期哮喘的關(guān)系。再通過(guò)進(jìn)行相應(yīng)的病例對(duì)照研究,驗(yàn)證本Meta分析的結(jié)果是否適用于國(guó)內(nèi)兒童。有助于規(guī)范生命早期抗生素的合理應(yīng)用,為未來(lái)找到預(yù)防和治療哮喘的方法和靶標(biāo)提供依據(jù)。方法:1、檢索中國(guó)知網(wǎng)數(shù)據(jù)庫(kù)、中國(guó)維普科技期刊數(shù)據(jù)庫(kù)、萬(wàn)方數(shù)據(jù)庫(kù)、Pub Med、EBSCO等中英文數(shù)據(jù)庫(kù)關(guān)于兒童哮喘與其1歲以前使用抗菌藥物的關(guān)系的前瞻性隊(duì)列研究,采用Stata12.0軟件,通過(guò)Meta分析方法探討二者之間的關(guān)系。2、選擇2016年6月-2016年12月在我院住院的首次診斷哮喘的患兒作為實(shí)驗(yàn)組。同時(shí)選取附近4家幼兒園、托兒所的健康兒童,其性別比例、年齡相仿的健康兒童作為對(duì)照組。采用問(wèn)卷調(diào)查的方式,根據(jù)國(guó)際兒童哮喘過(guò)敏研究(ISAAC)公認(rèn)的哮喘的發(fā)病原因進(jìn)行調(diào)查。運(yùn)用spss19.0對(duì)各暴露因素與疾病的關(guān)系進(jìn)行分析,采用多因素邏輯回歸建立模型,分析1歲以前抗生素的暴露與哮喘的關(guān)系。結(jié)果:1、選取文獻(xiàn)質(zhì)量評(píng)分高并且調(diào)整了呼吸道感染因素的效應(yīng)值進(jìn)行合并,共納入7項(xiàng)研究。Meta分析結(jié)果顯示,1歲以內(nèi)抗菌藥物的使用增加了兒童哮喘的風(fēng)險(xiǎn)(OR=1.13,95%CI:1.10~1.17,P0.05);1年內(nèi)使用抗菌藥物4次與使用0~1次相比哮喘風(fēng)險(xiǎn)增加(OR=1.28,95%CI:1.19~1.38,P0.05);高風(fēng)險(xiǎn)兒童(至少有1位直系親屬曾患有哮喘)1歲以前使用抗生素罹患哮喘的風(fēng)險(xiǎn)與沒(méi)有使用抗生素的高危兒童相比增加(OR=1.47,95%CI:1.20~1.81,P0.05)。2、分析納入實(shí)驗(yàn)組196位患兒,對(duì)照組205為健康兒童。對(duì)各暴露因素進(jìn)行分析結(jié)果顯示剖宮產(chǎn)、過(guò)敏性疾病家族史、近1年呼吸道感染大于6次、1歲以前及新生兒期抗生素的暴露被認(rèn)為是危險(xiǎn)因素,母乳喂養(yǎng)是保護(hù)因素。其中近1年呼吸道感染6次以上對(duì)模型的影響最大,調(diào)整呼吸道感染的因素1歲以內(nèi)抗生素的分析結(jié)果為OR=2.354,95%CI(1.478~3.750)。另外1歲以內(nèi)抗生素的使用2-3次數(shù)與使用1次比較,雖然P0.05,OR=1.131,95%CI(0.574~2.228)使用4次與使用1次比較有顯著的統(tǒng)計(jì)學(xué)差異,OR=2.320,95%CI(1.237~4.352)可以看出,隨著抗生素使用次數(shù)的增加哮喘的風(fēng)險(xiǎn)增加。結(jié)論:1、生后1年內(nèi)使用抗菌藥物增加兒童哮喘的風(fēng)險(xiǎn);高風(fēng)險(xiǎn)兒童使用抗菌藥物增加哮喘的風(fēng)險(xiǎn);抗菌藥物使用次數(shù)增加與哮喘風(fēng)險(xiǎn)增加有關(guān),但具體的劑量關(guān)系有待進(jìn)一步研究。2、1歲以內(nèi)抗生素的暴露增加了兒童時(shí)期罹患哮喘的風(fēng)險(xiǎn),且抗生素的使用次數(shù)越多則兒童時(shí)期罹患哮喘的風(fēng)險(xiǎn)越大。但由于本研究的樣本量偏小,只能在一定程度上說(shuō)明問(wèn)題,未來(lái)有待進(jìn)一步增大樣本量進(jìn)行研究。
[Abstract]:Objective: to evaluate the relationship between antibiotic use and childhood asthma before age 1 by Meta analysis of prospective cohort studies and relevant evidence-based medical evidence.A case-control study was conducted to verify the applicability of this Meta analysis to children in China.It is helpful to standardize the rational use of antibiotics in early life and to provide evidence for the prevention and treatment of asthma in the future.Methods: a prospective cohort study on the relationship between childhood asthma and the use of antimicrobial agents before the age of one year was searched in Chinese and English databases such as China knowledge Web Database, China Weip Science and Technology Journal Database, Wanfang Database, Pub MedBesco and so on. Stata12.0 software was used.To explore the relationship between them by Meta analysis, we selected the children who were hospitalized in our hospital from June 2016 to December 2016 as the experimental group.At the same time, the healthy children in 4 nearby kindergartens and nurseries were selected as the control group.The causes of asthma were investigated by questionnaire according to ISAAC, an international study of asthma allergy in children.Spss19.0 was used to analyze the relationship between various exposure factors and diseases, and multivariate logistic regression was used to establish a model to analyze the relationship between antibiotics exposure and asthma before one year of age.Results: 1, the literature quality score was high and the effect value of respiratory infection factors was adjusted for consolidation.The immediate family members had suffered from asthma before the age of one year, and the risk of developing asthma with antibiotics before the age of one year was higher than that of the high-risk children who did not use antibiotics. The analysis included 196 children in the experimental group.Control group 205 were healthy children.The analysis of exposure factors showed that the exposure of antibiotics before 1 year old and newborn stage was considered to be a risk factor and breast feeding was a protective factor in the family history of cesarean section and allergic diseases.The influence of respiratory tract infection more than 6 times in the last year on the model was the most significant. The results of the analysis of antibiotics within 1 year old adjusted for respiratory tract infection were as follows: ORN 2.354 ~ 95CII 1.478 ~ 3.750.Conclusion: one year after birth, the use of antimicrobial agents increases the risk of asthma in children, and the use of antibiotics increases the risk of asthma in high-risk children, and the increase in the frequency of use of antibiotics is related to the increased risk of asthma.However, the specific dose relationship needs to be further studied. Exposure to antibiotics less than 1 year old increases the risk of asthma in children, and the more antibiotics are used, the greater the risk of asthma in children.However, because the sample size of this study is too small, it can only explain the problem to some extent, and further increase the sample size is needed to be studied in the future.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 齊志業(yè);段晶;熊晶晶;張泉;曹志郎;戴梅;莫亞雄;魯萍;;昆明市城區(qū)兒童哮喘經(jīng)濟(jì)負(fù)擔(dān)分析[J];衛(wèi)生軟科學(xué);2016年08期

2 謝新鑫;楊青廷;曠滿華;劉洋;張濤;李鋼強(qiáng);讓蔚清;;2004～2015年中國(guó)兒童抗生素使用情況分析[J];中南醫(yī)學(xué)科學(xué)雜志;2016年02期

3 柯宇星;鄭潔麗;吳春遠(yuǎn);;小兒支氣管哮喘相關(guān)影響因素分析研究[J];臨床肺科雜志;2015年07期

4 楊峻山;楊曉霞;李曉春;;兒童病毒性腹瀉的病原學(xué)監(jiān)測(cè)結(jié)果分析[J];疾病預(yù)防控制通報(bào);2015年04期

5 鄧曉燕;;抗生素在兒科急性上感中的應(yīng)用[J];臨床醫(yī)藥文獻(xiàn)電子雜志;2015年12期

6 蔣素琴;;淺談抗生素在兒科上呼吸道感染中的臨床應(yīng)用[J];醫(yī)療裝備;2015年03期

7 姜淑艷;;抗生素在兒科呼吸道感染中的臨床應(yīng)用與分析[J];中國(guó)現(xiàn)代藥物應(yīng)用;2015年03期

8 門曉英;方文;張麗范;郭小芳;黎艷梅;;廣東江門地區(qū)早產(chǎn)與嬰幼兒哮喘發(fā)病關(guān)系的前瞻性研究[J];中國(guó)婦幼保健;2012年29期

9 馮曉莉;葛玲霞;;兒科呼吸道感染應(yīng)用抗生素現(xiàn)狀分析[J];內(nèi)蒙古中醫(yī)藥;2010年21期

10 白漢玉;韓秀蘭;;反復(fù)感染綜合征[J];中國(guó)臨床醫(yī)生;2009年01期

相關(guān)博士學(xué)位論文 前1條

1 馮曉凱;我國(guó)支氣管哮喘患病情況及相關(guān)危險(xiǎn)因素的流行病學(xué)調(diào)查[D];北京協(xié)和醫(yī)學(xué)院;2014年

相關(guān)碩士學(xué)位論文 前1條

1 王欣欣;孕期和新生兒期因素與兒童支氣管哮喘發(fā)病的相關(guān)性研究[D];青島大學(xué);2012年

，

本文編號(hào)：1737447