婴儿辅食添加的时机与食物过敏发生的系统综述和Meta分析  

Timing of food introduction to the infant diet and risk of food allergy:a systematic review and Meta-analysis

作　　者：代妮妮 李心悦 王硕[1] 王佳佳 高亚娟[1] 李在玲[1] Dai Nini;Li Xinyue;Wang Shuo;Wang Jiajia;Gao Yajuan;Li Zailing(Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院儿科,100191

出　　处：《中华儿科杂志》2021年第7期563-569,共7页Chinese Journal of Pediatrics

摘　　要：目的探讨婴儿辅食添加的时机与食物过敏发生的关系。方法检索PubMed、The Cochrane Library、中国知网、万方数据库中婴儿辅食早期引入对食物过敏发生的影响的随机对照试验(RCT),限定时间均为建库至2019年12月31日。筛选出的文献质量评价采用Cochrane手册中的偏倚风险评价工具进行评价,使用RevMan 5.3软件进行Meta分析,对于纳入文献较少的辅食种类则进行系统综述。结果共纳入8个RCT,按照食物种类分组进行Meta分析或系统综述。Meta分析结果显示,与晚期(即6月龄后)引入组相比,婴儿辅食中早期(即6月龄前)引入鸡蛋(RR=0.60,95%CI 0.46~0.79)可降低鸡蛋过敏发生的风险。针对所纳入的添加辅食为鸡蛋的6个研究的亚组分析结果显示,在有过敏性疾病的既往史或家族史的婴儿,6月龄前引入鸡蛋可降低鸡蛋过敏的发生(RR=0.55,95%CI 0.40~0.75);6月龄前引入生鸡蛋(RR=0.67,95%CI 0.49~0.93)、小剂量的鸡蛋(相当于每周蛋白质0~4 g)(RR=0.55,95%CI 0.36~0.85)均与鸡蛋过敏的发生风险降低有关;此外,与4月龄前开始添加鸡蛋相比,4~6月龄期间添加鸡蛋可降低鸡蛋过敏的发生(RR=0.58,95%CI 0.43~0.78)。在系统综述中,早期引入花生对婴儿花生过敏发生的影响暂无定论,所纳入的RCT均显示早期引入牛奶蛋白对婴儿牛奶蛋白过敏的发生无统计学意义(P>0.05)。结论婴儿辅食中早期(即6月龄前)引入鸡蛋可预防婴儿鸡蛋过敏的发生,但需考虑研究的局限性。Objective To evaluate the relationship between the timing of complementary feeding for infants and the occurrence of food allergy.Methods The PubMed,Cochrane Library,China National Knowledge Infrastructure(CNKI),and WanFang Data database were searched for randomized controlled trials(RCTs)about the effects of early introduction of complementary foods in infants on the occurrence of food allergy.Papers published from the establishment of the databases to December 31,2019 were extracted.The quality of the selected literature was evaluated using the risk-of-bias(ROB)tools in the Cochrane Handbook,and the RevMan 5.3 software was used for meta-analysis.For the complementary food analyzed in a few reports in literature,a systematic review was conducted.Results A total of 8 RCTs were extracted,and the systematic review and Meta-analysis were carried out according to food types.The results of Meta-analysis showed that compared with late introduction(after 6 months of age),early introduction(before 6 months of age)of eggs(RR=0.60,95%CI 0.46-0.79)could reduce the risk of egg allergy in infants.The subgroup analysis of the six studies about eggs demonstrated that in infants with a prior or family history of allergic diseases,the introduction of eggs before 6 months of age was associated with reduced risk of egg allergy(RR=0.55,95%CI 0.40-0.75),and the introduction of raw eggs(RR=0.67,95%CI 0.49-0.93)and small amount of eggs(equivalent to weekly protein 0-4 g)(RR=0.55,95%CI 0.36-0.85)before 6 months of age were also associated with reduced risk of egg allergy.In addition,egg supplementation during 4-6 months of age reduced the occurrence of egg allergy compared with supplementation before 4 months of age(RR=0.58,95%CI 0.43-0.78).The systematic review found no conclusive relationship between early peanut introduction and peanut allergy,nor the correlation between early cow′s milk protein introduction and cow′s milk protein allergy(P>0.05).Conclusion Early introduction(before 6 months of age)of eggs in infants′complement

关 键 词：食物过敏 婴儿 META分析 

分 类 号：R725.9[医药卫生—儿科]