早期抗生素暴露与儿童肥胖风险的Meta分析

目的 系统评价早期抗生素暴露与儿童肥胖风险的相关性。方法 计算机检索PubMed、CNKI、维普期刊和万方等数据库，检索时限为从建库至2017年9月，由2位研究员独立筛选早期抗生素暴露与儿童肥胖风险的队列研究，提取资料并评价纳入研究的质量，采用Stata 12.0软件进行Meta分析。结果 纳入15个队列研究，共465648例研究对象。Meta分析结果显示：①早期抗生素暴露会增加儿童超重和肥胖的风险(超重：RR=1.20，95%CI 1.08~1.32；肥胖：RR=1.23，95%CI 1.19~1.27)；②以性别为亚组进行分析，男孩亚组和女孩亚组都有超重的风险(男：RR=1.35，95%CI 1.17~1.53；女：RR=1.17，95%CI 1.00~1.33)；③早期抗生素暴露会增加儿童BMI z值和体重z值(BMI z值：MD=0.06，95%CI 0.03~0.08；体重z值：MD=0.07，95%CI 0.02~0.11)。结论 早期抗生素暴露会增加儿童肥胖风险，儿童使用抗生素需谨慎。鉴于纳入文献的质量和样本来源问题，结论尚需进一步验证。     

Early pathogenesis of atherosclerosis: the childhood obesity

Obesity represents a chronic inflammatory status and adipocytes release either cytokines or an array of adipokines such as leptin, endowed with immunomodulating and systemic activities. The involvement of cytokines in obesity as well as of the adipokine leptin is supported by the notion that weight reduction normalizes mediators of inflammation. In this framework, we will demonstrate that in obese children, subjected for a period of six months to a hypocaloric diet, reduction of major biochemical and anthropometric parameters correlates with a normalization of immune status. In fact, absolute numbers of CD4+ cells and CD4/CD8 ratio increase, while leptin values fluctuate within normal ranges, being this adipokine involved in the modulation of either innate or adaptive immune responses. In the discussion, the immune abnormalities detected in obesity will be pointed out and emphasis will be placed on the increased frequency of infectious episodes occurring in obese adolescent and adults. Finally, the infectious etiology of obesity will be illustrated in the sense that adipocytes interacting with infectious agents may cause obesity. Taken together, the bulk of available data indicate that childhood obesity should be prevented or reduced to avoid more serious complications in adulthood.