Adekunle Gregory Fakunle, Nkosana Jafta, Rajen N Naidoo, Lidwien A M Smit
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Studies that investigated the exposure-response relationship between components of the indoor microbial communities and respiratory symptoms among under-five children were eligible for inclusion. A random-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI) for study specific high versus low microbial exposures. The potential effect of individual studies on the overall estimate was evaluated using leave-one-out analysis, while heterogeneity was evaluated by I<sup>2</sup> statistics using RevMan 5.3.</p><p><strong>Results: </strong>Fifteen studies were eligible for inclusion in a meta-analysis. The pooled risk estimate suggested that increased microbial exposure was associated with an increased risk of respiratory symptoms [pooled relative risk (RR): 1.24 (1.09, 1.41), P = 0.001]. The association was strongest with exposure to a combination of Aspergillus, Penicillium, Cladosporium and Alternaria species [pooled RR: 1.73 (1.30, 2.31), P = 0.0002]. Stratified analysis revealed an increased risk of wheeze [pooled RR: 1.20 (1.05, 1.37), P = 0.007 and allergic rhinitis [RR: 1.18 (0.94, 1.98), P = 0.16] from any microbial exposure.</p><p><strong>Conclusions: </strong>Microbial exposures are, in general, associated with risk of respiratory symptoms. 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引用次数: 7
摘要
背景:尽管人们认识到室内微生物暴露对儿童健康的重要性，但不同微生物制剂在呼吸道症状和疾病的发生和加重中的作用却知之甚少。本研究旨在评估在室内环境中暴露于微生物气溶胶是否与5岁以下儿童的呼吸道症状有关。方法:系统检索PubMed、Web of Science、GreenFILE、ScienceDirect、EMBASE和Cochrane图书馆截至2020年2月的文献。调查室内微生物群落组成部分与5岁以下儿童呼吸道症状之间的暴露-反应关系的研究符合纳入条件。应用随机效应荟萃分析来估计研究特定的高与低微生物暴露的总相对风险(RR)和95%置信区间(CI)。使用留一分析评估个别研究对总体估计的潜在影响，使用RevMan 5.3进行I2统计评估异质性。结果:15项研究符合纳入meta分析的条件。综合风险估计表明，微生物暴露增加与呼吸道症状风险增加相关[综合相对风险(RR): 1.24 (1.09, 1.41)， P = 0.001]。与曲霉、青霉菌、枝孢菌和交替菌组合暴露的相关性最强[合并RR: 1.73 (1.30, 2.31)， P = 0.0002]。分层分析显示，任何微生物暴露都增加了喘息[合并RR: 1.20 (1.05, 1.37)， P = 0.007]和变应性鼻炎[RR: 1.18 (0.94, 1.98)， P = 0.16]的风险。结论:微生物暴露通常与呼吸道症状的风险相关。未来的研究需要更全面地研究室内微生物群，并探讨这些关联的机制。
Association of indoor microbial aerosols with respiratory symptoms among under-five children: a systematic review and meta-analysis.
Background: Despite the recognition of the importance of indoor microbial exposures on children's health, the role of different microbial agents in development and aggravation of respiratory symptoms and diseases is only poorly understood. This study aimed to assess whether exposure to microbial aerosols within the indoor environment are associated with respiratory symptoms among children under-5 years of age.
Methods: A systematic literature search was conducted on PubMed, Web of Science, GreenFILE, ScienceDirect, EMBASE and Cochrane library through February 2020. Studies that investigated the exposure-response relationship between components of the indoor microbial communities and respiratory symptoms among under-five children were eligible for inclusion. A random-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI) for study specific high versus low microbial exposures. The potential effect of individual studies on the overall estimate was evaluated using leave-one-out analysis, while heterogeneity was evaluated by I2 statistics using RevMan 5.3.
Results: Fifteen studies were eligible for inclusion in a meta-analysis. The pooled risk estimate suggested that increased microbial exposure was associated with an increased risk of respiratory symptoms [pooled relative risk (RR): 1.24 (1.09, 1.41), P = 0.001]. The association was strongest with exposure to a combination of Aspergillus, Penicillium, Cladosporium and Alternaria species [pooled RR: 1.73 (1.30, 2.31), P = 0.0002]. Stratified analysis revealed an increased risk of wheeze [pooled RR: 1.20 (1.05, 1.37), P = 0.007 and allergic rhinitis [RR: 1.18 (0.94, 1.98), P = 0.16] from any microbial exposure.
Conclusions: Microbial exposures are, in general, associated with risk of respiratory symptoms. Future studies are needed to study the indoor microbiome more comprehensively, and to investigate the mechanism of these associations.
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