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妊娠期妇女摄入源自鱼油的脂肪酸与其子女发生哮鸣和哮喘之间的关系
Fish Oil–Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring


Hans Bisgaard ... 呼吸系统疾病 围产医学和儿科 • 2016.12.29
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儿童哮喘和哮鸣预防探索

 

陈倩†*,申昆玲‡*

† 北京大学第一医院妇产科;‡ 首都医科大学附属北京儿童医院呼吸科

* 共同通讯作者

 

众所周知,作为出生缺陷的预防分为三级,目前在中国推行的成功一级预防是叶酸的摄入明显地降低了开放性神经管畸形的发生。同样,美国Barker教授提出的DohaH理论1,提示人类许多成人疾病可能与宫内环境相关。尽管遗传因素对人类健康起到决定性的作用,但是宫内环境,尤其是宫内的营养因素,有可能通过表观遗传的方式改变人类对疾病的易感性。这些理论促使科学家探索胎儿宫内环境的干预是否可以减少疾病的发生。

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摘要


背景

n-3长链多不饱和脂肪酸(LCPUFA)摄入减少可能是逐渐增加的哮鸣疾病患病率的一个促发因素。我们评估了妊娠妇女补充n-3 LCPUFA对其子女的持续性哮鸣和哮喘发生危险产生的影响。

 

方法

我们将736名妊娠24周的妊娠妇女随机分配接受每日2.4 g n-3 LCPUFA(鱼油)或安慰剂(橄榄油)。她们的子女组成了哥本哈根儿童哮喘的前瞻性研究2010(Copenhagen Prospective Studies on Asthma in Childhood2010,COPSAC2010)队列,我们对其进行了包含广泛临床表型分析的前瞻性随访。儿童出生后的前3年随访期间,无论研究人员还是参与者均不知晓分组情况,之后的2年随访期间,只有研究人员不知晓分组情况。主要终点是持续性哮鸣或哮喘,次要终点包括下呼吸道感染、哮喘加重、湿疹和变应性致敏。

 

结果

共有695名儿童被纳入试验,其中95.5%完成了3年的双盲随访期。治疗组发生持续性哮鸣或哮喘的危险度为16.9%,与之相比对照组为23.7%(风险比为0.69;95%置信区间[CI]为0.49~0.97;P=0.035),相当于30.7%的相对降幅。预先设定的亚组分析提示,在随机分组时二十碳五烯酸和二十二碳六烯酸血液水平在试验人群最低1/3的女性所生的儿童中效应最强:17.5%对34.1%(风险比为0.46;95% CI为0.25~0.83;P=0.011)。对次要终点所做的分析表明,补充n-3 LCPUFA与下呼吸道感染的发生危险降低相关(31.7%对39.1%;风险比为0.75;95% CI为0.58~0.98;P=0.033),但是补充n-3 LCPUFA与哮喘加重、湿疹或变应性致敏之间无统计学上显著的关联。

 

结论

在妊娠末三个月补充n-3 LCPUFA使子女发生持续性哮鸣或哮喘及下呼吸道感染的绝对危险度降低了大约7个百分点或1/3(由灵北基金会[Lundbeck Foundation]等资助;ClinicalTrials.gov注册号为NCT00798226)。





作者信息

Hans Bisgaard, M.D., D.M.Sc., Jakob Stokholm, M.D., Ph.D., Bo L. Chawes, M.D., Ph.D., D.M.Sc., Nadja H. Vissing, M.D., Ph.D., Elin Bjarnadóttir, M.D., Ann-Marie M. Schoos, M.D., Ph.D., Helene M. Wolsk, M.D., Tine M. Pedersen, M.D., Rebecca K. Vinding, M.D., Sunna Thorsteinsdóttir, M.D., Nilofar V. Følsgaard, M.D., Ph.D., Nadia R. Fink, M.D., Jonathan Thorsen, M.D., Anders G. Pedersen, Ph.D., Johannes Waage, Ph.D., Morten A. Rasmussen, Ph.D., Ken D. Stark, Ph.D., Sjurdur F. Olsen, M.D., D.M.Sc., and Klaus Bønnelykke, M.D., Ph.D.
From COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen (H.B., J.S., B.L.C., N.H.V., E.B., A.-M.M.S., H.M.W., T.M.P., R.K.V., S.T., N.V.F., N.R.F., J.T., J.W., M.A.R., K.B.), and the Center for Fetal Programming, Statens Serum Institut (S.F.O.), Copenhagen, the Department of Pediatrics, Naestved Hospital, Naestved (J.S., E.B., T.M.P., R.K.V.), DTU Bioinformatics, Technical University of Denmark, Kongens Lyngby (A.G.P.), and Faculty of Science, Chemometrics and Analytical Technology, University of Copenhagen (M.A.R.) — all in Denmark; the Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada (K.D.S.); and the Department of Nutrition, Harvard School of Public Health, Boston (S.F.O.). Address reprint requests to Dr. Bisgaard at COPSAC, Herlev and Gentofte Hospital, University of Copenhagen, Ledreborg Alle 34, DK-2820 Gentofte, Copenhagen, Denmark, or at bisgaard@copsac.com.

 

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