분만 방법이 소아 알레르기질환의 유병률에 미치는 영향
Prevalence of Allergic Diseases in Children according to Mode of Delivery
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목적:위생가설에 따르면 제왕절개 수술에 의한 분만은 알레르기질환 발병의 위험요인이 될 수 있지만, 아직까지는 논란의 여지가 있다. 본 연구에서는 분만 방법과 알레르기질환의 발생과 연관이 있는지 알아보고자 하였다. 방 법:2008년 4월부터 10월까지 서울시내 8,404명의 초 중등학교 학생들을 대상으로 ISAAC 연구와 동일한 설문지를 이용하여 역학조사를 시행하였고, 대상자들을 제왕절개분만군과 질식분만군으로 분류하여, 천식, 알레르기비염, 아토피피부염의 유병률을 비교하였다. 결 과:제왕절개분만군과 질식분만군 사이에 ‘일생 동안 천명(P=0.418)’, ‘지난 12개월 동안 천명(P=0.152)’과 ‘일생 동안 천식 진단(P=0.382)’ 모두 유병률의 차이를 보이지 않았다. ‘일생 동안 비염 증상(P=0.609)’, ‘지난 12개월 동안 비염 증상(P=0.788)’과 ‘일생 동안 알레르기비염 진단(P=0.700)’의 유병률 또한 두 군간의 차이를 보이지 않았으며, ‘일생 동안 가려움을 동반한 피부염(P=0.065)’, ‘지난 12개월 동안 가려움을 동반한 피부염(P=0.381)’, 그리고 ‘일생 동안 아토피피부염 진단(P=0.162)’의 유병률 또한 유의한 차이를 보이지 않았다. 그러나, 알레르기질환의 가족력이 있는 대상자들의 경우, 제왕절개분만군이 질식분만군과 비교하여 일생 동안 천식 진단의 유병률이 유의하게 높았다.(11.3% vs. 9.2%, P=0.032)결 론:우리나라 서울 초, 중등학생들을 대상으로 역학조사를 실시한 결과 분만방법과 천식, 알레르기비염, 아토피피부염 발생과는 유의한 관련성을 보이지 않지만, 알레르기질환의 가족력이 있는 경우에는 제왕절개분만이 천식 발생의 위험을 증가시킨다.
Abstract
Purpose:It has been suggested that caesarean section is a risk factor for allergic diseases under the ‘hygiene hypothesis’, but it remains controversial. In this study, we examined the association between mode of delivery and development of allergic diseases. Methods:The Korean International Study of Asthma and Allergies in Childhood questionnaire was used to survey 8,404 elementary and middle-school students in Seoul between April and October 2008. We categorized children into a caesarean section group and a vaginal delivery group, and surveyed the prevalence of asthma, allergic rhinitis, and atopic dermatitis Results:No differences in the prevalence of “wheeze ever” (P=0.418), “wheezing the last 12 months” (P=0.152), and “diagnosis of asthma ever” (P=0.382) were observed between the caesarean section group and the vaginal delivery group. The prevalence of “rhinitis ever” (P=0.609), “rhinitis the last 12 months” (P=0.788), and “diagnosis of allergic rhinitis ever” (P=0.700) was also similar between the two groups. The prevalence of “itchy eczema ever” (P=0.065), “itchy eczema last 12 months” (P=0.381), and a “diagnosis of atopic dermatitis ever” (P=0.162) also did not show any differences between the two groups. However, in subjects with a family history of allergic disease, the caesarean section group had the higher prevalence of “diagnosis of asthma ever” (11.3% vs. 9.2%, P=0.032) than that in the vaginal delivery group. Conclusion:We found an association between mode of delivery and the subsequent development of asthma in children with a family history of allergic disease in Seoul, Korea.
참고문헌 (30)
- Strachan DP, "Hay fever, hygiene, and household size", BMJ, 299, pp.1259~1260 (1989)
- Wold AE, "The hygiene hypothesis revised: is the rising frequency of allergy due to changes in the intestinal flora", Allergy, 53(46 Suppl), pp.20~25 (1998)
- Mitsou EK, "Fecal microflora of Greek healthy neonates", Anaerobe, 14, pp.94~101 (2008)
- Björkstén B, "The intestinal microflora in allergic Estonian and Swedish 2-year-old children", Clin Exp Allergy, 29, pp.342~346 (1999)
- Menacker F, "Trends in cesarean rates for first births and repeat cesarean rates for low-risk women: United States, 1990-2003", Natl Vital Stat Rep, 54, pp.1~8 (2005)
- 2007 Annual report on the appropriacy of the caesarean section delivery, , Health Insurance Review & Assessment Service, ~ (2008)
- Eder W, "The asthma epidemic", N Engl J Med, 355, pp.2226~2235 (2006)
- 지혜미, "2006년 초등학생의 알레르기 질환 유병률의 전국적 역학조사", 대한소아알레르기및호흡기학회지, 19(2), pp.165~172 (2009), 대한 소아알레르기 호흡기학회
- Xu B, "Caesarean section and risk of asthma and allergy in adulthood", J Allergy Clin Immunol, 107, pp.732~733 (2001)
- Roduit C, "Asthma at 8 years of age in children born by caesarean section", Thorax, 64, pp.107~113 (2009)
- Salam MT, "Mode of delivery is associated with asthma and allergy occurrences in children", Ann Epidemiol, 16, pp.341~346 (2006)
- Negele K, "Mode of delivery and development of atopic disease during the first 2 years of life", Pediatr Allergy Immunol, 15, pp.48~54 (2004)
- Mallen CD, "Birth-related exposures and asthma and allergy in adulthood: a population-based cross- sectional study of young adults in North Staffordshire", J Asthma, 45, pp.309~312 (2008)
- Maitra A, "Mode of delivery is not associated with asthma or atopy in childhood", Clin Exp Allergy, 34, pp.1349~1355 (2004)
- Menezes AM, "Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil", Clin Exp Allergy, 41, pp.218~223 (2011)
- 손명현, "mode of delivery in childbirth and prevalence", Allergy, Asthma & Immunology Research, 2(1), pp.28~33 (2010), 대한천식알레르기학회
- Soo-JongHong, "The Validity of the ISAAC Written Questionnaire and the ISAAC Video Questionnaire (AVQ 3.0) for Predicting Asthma Associated with Bronchial Hyperreactivity in a Group of 13-14 Year Old Korean Schoolchildren", Journal of Korean Medical Science, 18(1), pp.48~52 (2003), 대한의학회
- Bager P, "Caesarean delivery and risk of atopy and allergic disease: meta-analyses", Clin Exp Allergy, 38, pp.634~642 (2008)
- Thavagnanam S, "A meta-analysis of the association between Caesarean section and childhood asthma", Clin Exp Allergy, 38, pp.629~633 (2008)
- Ly NP, "Mode of delivery and cord blood cytokines: a birth cohort study", Clin Mol Allergy, 4, pp.13~ (2006)
- Tadaki H, "Association of cord blood cytokine levels with wheezy infants in the first year of life", Pediatr Allergy Immunol, 20, pp.227~233 (2009)
- Smith GC, "Neonatal respiratory morbidity at term and the risk of childhood asthma", Arch Dis Child, 89, pp.956~960 (2004)
- Schaubel D, "Neonatal characteristics as risk factors for preschool asthma", J Asthma, 33, pp.255~264 (1996)
- Tollånes MC, "Cesarean section and risk of severe childhood asthma: a population-based cohort study", J Pediatr, 153, pp.112~116 (2008)
- Pistiner M, "Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy", J Allergy Clin Immunol, 122, pp.274~279 (2008)
- Al-Kubaisy W, "Risk factors for asthma among primary school children in Baghdad, Iraq", Saudi Med J, 26, pp.460~466 (2005)
- Sugiyama M, "Early-life risk factors for occurrence of atopic dermatitis during the first year", Pediatrics, 119, pp.e716~23 (2007)
- Bager P, "Birth by caesarean section and wheezing, asthma, allergy, and intestinal disease", Clin Exp Allergy, 41, pp.147~148 (2011)
- Crump C, "Risk of asthma in young adults who were born preterm: a Swedish national cohort study", Pediatrics, 127, pp.e913~20 (2011)
- Hikino S, "Food allergy and atopic dermatitis in low birthweight infants during early childhood", Acta Paediatr, 90, pp.850~855 (2001)