早期婴儿同胞接触与多发性硬化症发病风险的关系

作     者：Ponsonby A.- L. Van Der Mei I. Dwyer T. 黄卫东 

作者机构：Natl. Ctr. for Epidemiol./Pop. Hlth. Australian National University Canberra ACT 0200 Australia Dr. 

出 版 物：《世界核心医学期刊文摘（神经病学分册）》 (Digest of the World Core Medical Journals:Clinical Neurology)

年 卷 期：2005年第1卷第6期

页      面：6-6页

学科分类：1002[医学-临床医学] 100204[医学-神经病学] 10[医学] 

主　　题：多发性硬化症 发病风险 感染负荷 单核细胞增多症 参考值 接触感染 病毒感染 感染模式 免疫反应性 塔斯马尼亚 

摘      要：Context: The “ hygiene hypothesis has implicated sibship as a marker of infection load during early life and suggests that exposure or reexposure to infections can influence the developing immune system. Viral infection has also been implicated in the pathogenesis of multiple sclerosis (MS). Abstract:Objectives: To evaluate whether exposure to infant siblings in early life is associated with the risk of MS, and to explore the possible mechanism for any apparent protective effect, including altered Epstein- Barr virus (EBV) infection patterns. Design, Setting, and Patients: Population- based case- control study in Tasmania, Australia, from 1999 to 2001 based on 136 cases of magnetic resonance imaging- confirmed MS and 272 community controls, matched on sex and year of birth. Main Outcome Measure: Risk of MS by duration of contact with younger siblings aged less than 2 years in the first 6 years of life. Results: Increasing duration of contact with a younger sibling aged less than 2 years in the first 6 years of life was associated with reduced MS risk (adjusted odds ratios [AORs]: 1 infant- year, 1.00 [reference]; 1 to 3 infant- years, 0.57 [95% confidence interval {CI}, 0.33- 0.98]; 3 to 5 infant- years, 0.40 [95% CI, 0.19- 0.92]; ≥ 5 infantyears, 0.12 [95% CI, 0.02- 0.88]; test for trend, P=.002). A history of exposure to infant siblings was associated with a reduced IgG response to EBV among controls. Controls with at least 1 infant- year contact had a reduced risk of infectious mononucleosis and a reduced risk of very high composite EBV IgG titers (AOR, 0.33; 95% CI, 0.11- 0.98) compared with other controls. The inverse association between higher infant contact and MS was independent of EBV IgG titer. Conclusion: Higher infant sibling exposure in the first 6 years of life was associated with a reduced risk of MS, possibly by altering childhood infection patterns and related immune responses.