剖宫产可能增加儿童罹患过敏性疾病风险的Meta分析

目的 利用Meta分析方法评价剖宫产与儿童过敏性疾病之间的关系,为儿童过敏性疾病防治提供循证依据。方法 检索五大数据库,最后一次检索时间为2017年9月5日,按照预先设定的标准检索、筛选、纳入和分析文献。采用Rev Man 5.3软件进行Meta分析,根据异质性结果选择相应的效应模型分析并进行亚组分析。结果 共有63篇文献纳入分析,总样本量为4 818 347人。与阴道分娩相比,剖宫产儿哮喘、食物过敏、过敏性鼻结膜炎、吸入性过敏、喘息、枯草热的患病率分别增加19%、31%、14%、29%、4%、16%(P＜0.05)。亚组分析显示:对儿童哮喘而言,剖宫产不增加3岁以下儿童哮喘发生风险,其余各亚组差异均有统计学意义(P＜0.05);对儿童喘息而言,队列研究、通过问卷调查(父母报告症状)、父母无过敏性疾病组,剖宫产与儿童喘息有关联,OR值分别为1.05(95%CI:1.01~1.08)、1.07(95%CI:1.01~1.14)、1.05(95%CI:1.00~1.10)。结论 剖宫产是儿童多种过敏性疾病的危险因素,应做好孕产妇健康宣教和产科质量管理,把好儿童生命质量第一关。

Meta-analysis of caesarean section may increase the risk of childhood allergic diseases

Objective To analyze the correlation between caesarean section and allergic diseases in childhood by conducting a meta-analysis, in order to provide evidence for the prevention of childhood allergic diseases. Methods Literatures published till 5th September, 2017 were searched in five databases, and were retrieved, filtered, incorporated and analyzed according to the preset standard.Meta-analysis was performed by using Rev Man 5.3 software.The corresponding effect model was selected according to the heterogeneity results and subgroup analysis was performed. Results Totally 63 studies were included, the sample size was 4 818 347.Compared with natural birth, caesarean section significantly increased the risks of having asthma, food allergy, allergic conjunctivitis, inhalation allergy, wheezing and hay fever in children by 19%, 31%, 14%, 29%, 4% and 16%, respectively(P＜0.05).Subgroup analysis showed that cesarean section did not increase the risk of asthma in children under 3 years old, while other subgroups were statistically significant (P<0.05).Caesarean section was associated with children's wheezing among the subgroups of cohort study(OR=1.05,95%CI:1.01～1.08),questionnaire(parents reported symptoms)(OR=1.07,95%CI:1.01～1.14)and parents without allergic diseases(OR=1.05, 95%CI:1.00～1.10). Conclusion Caesarean section increases the risk of allergic diseases in childhood, so it is necessary to strengthen maternal health education and obstetric management to guarantee healthy life of children.