生物与医学2022ncbi.nlm.nih.gov
儿童期抗生素使用是克罗恩病的风险因素：队列研究
Childhood antibiotics as a risk factor for Crohn's disease: Cohort study
入门 · 约 35 分钟读完前置知识：流行病学基础、肠道菌群概念
导读
这项队列研究探讨儿童期使用抗生素是否增加日后患克罗恩病（Crohn's disease）的风险。研究汇总了包括中国和澳大利亚在内的多个人群数据，发现18岁前使用抗生素在中国人群中与克罗恩病发病显著相关（校正OR约4.8），但在澳大利亚人群中未观察到显著关联。
HN 关注点：抗生素对肠道菌群的长期影响是 HN 读者长期关注的话题，讨论焦点集中在研究结果是否稳健以及医生滥用抗生素的问题。
HN 评论精选
这几条评论里：质疑 1 补充 1 亲历 2
质疑质疑结论稳健性：亚组间结果不一致说明发现可能不可靠
一方面我觉得儿童期抗生素扰乱消化道免疫系统完全说得通；但另一方面，亚组分析显示抗生素使用在18岁以下是中国人群的克罗恩病风险因素（校正OR 4.80, 95% CI 1.62–12.24; P=0.005），在澳大利亚人群中却不显著（OR 1.80, 95% CI 0.33–9.95; P=0.498）。如果这是一个可靠的发现，就不应该在亚组分析中崩塌。
rossdavidh查看英文原文
On the one hand, it makes total sense to me that childhood antibiotics could mess up your digestive tract immune system. On the other hand: "Subgroup analysis showed that antibiotic use <18 years old was a risk factor for CD development in the Chinese (adjusted OR 4.80, 95% CI 1.62–12.24; P = 0.005) but not in Australian populations (OR 1.80, 95% CI 0.33–9.95; P = 0.498)." If it were a robust finding, it would not fall apart on subgroup analysis.
亲历亲历：医生普遍低估抗生素风险，不良反应上报和告知严重缺失
医疗体系需要彻底改革，很多医生完全不了解抗生素等药物的风险。有研究发现只有7%的医生上报过不良反应，有的害怕、有的不会、有的没时间，有的医生执业近一生从未上报。我16到22岁时因痤疮多次服用6个月以上的多西环素疗程，多位皮肤科医生都说囊肿性痤疮无药可治。后来我厌倦了多西环素的糟糕感觉，自己研究护肤，只要用温和洁面产品每天两次、保湿、不碰脸，囊肿性痤疮就完全消失——但没有任何医生告诉过我这些。之后我对环丙沙星产生不良反应，40多位医生无视之，说是我心理问题，后来FDA才加了永久性神经损伤的警告。我至今仍要给医生寄研究文献，因为他们还说我错了。我协助管理一个氟喹诺酮毒性群组，每天都有人因疑似感染被开了这些本应是最后手段的药，这近乎医疗事故。
codeTired查看英文原文
The healthcare needs to be completely overhauled. So many doctors are completely ignorant of risks of antibiotics and other meds. There was a study that found 7% of doctors reported adverse reactions. Some were scared, some didn’t know how, some didn’t have time. Some doctors made no reports in nearly lifetime of practice. When I was 16-22 I had multiple 6+ months courses of doxycycline for acne. I have seen multiple dermatologist who said nothing can be done about my cystic acne. At some point I was tired of doxy making me feel awful so I researched different skin types and skin care routines. As long as I use a mild soap twice a day, use a moisturizer and don’t touch my skin I get 0 cystic acne but it took weeks to see the results. No doctor ever told me about different types of skin and I was young and dumb. My parents didn’t know any better. And internet wasn’t as popular back then. Then, I got an adverse reaction to cipro. And 40+ doctors ignored it. Told me it’s all in my head. Told me to seek help for my mental health and depression. Later FDA added warning about permanent nerve damage. I still have to send studies to doctors because they try to tell me I’m wrong, after I had every test under the sun to rule out other causes. I help admin flouroquinolone toxicity group and every day we get individuals who were given these last resort meds for suspected infection. It is border line medical malpractice. However, I have seen that it is impossible to find a lawyer to take the case and find a physician willing to testify. There needs to be a better system for tracking allergic reactions and trends. For example, cipro might show no reaction up to 6 months. Then, you snap your Achilles. The doctor won’t tell you it was cipro unless you tell him. It’s fucked and extremely underreported.
补充科普：抗生素造成的菌群损失（如关键菌种）可能永久且难以修复
抗生素的实际伤害比我们意识到的更大。西方人的消化道菌群与不使用抗生素治疗的人群有显著差异，一些丢失的物种非常重要，而我们目前无法修复：比如对能量代谢至关重要的 Faecalibacterium prausnitzii 无法在有氧环境中存活，一旦被杀死可能永远消失。又如 Limosilactobacillus reuteri 能抑制真菌和其他细菌在小肠定植，但它对抗生素非常敏感，如今只有约5%的人还携带。我们并不知道理想菌群是什么样，只知道西方大多数人的菌群不健康、缺少关键物种，而我们的理解才刚起步。
PaulKeeble查看英文原文
Antibiotics are actually really more damaging than we realise. Western digestive tracts show significant differences in microbiome that those of people who do not use antibiotics as treatment and some of the lost species are really important. We also have no way to fix it currently, some of the species like Faecalibacterium Prausnitzii are critical to our bodies energy system but can't survive in oxygen, so we have no way to eat it at all, you kill it then its gone likely for good. Others like Limosilactobacillus reuteri stop fungus from inhabiting our small intestine as well as other bacteria but just 5% of us still have some of it as its very susceptible to antibiotics. We don't know what ideal microbiomes look like, we just know the bulk of people living in the western world have unhealthy ones that are missing key species and we have only scratched the surface of understanding.
亲历亲历分享：罗伊氏乳杆菌益生菌改善了其肠道问题，并附相关研究
我曾在巴拿马一个热带岛屿因饮水患上严重肠易激综合征，痛苦了好几年，连医生朋友都说只能硬扛。直到我发现罗伊氏乳杆菌（L. Reuteri），据说这种菌在1950年代加工食品流行前更常见，它彻底改变了我的生活。它会分泌一种叫 Reuterin 的物质，抑制其他更有害细菌的生长。我无法亲身体会克罗恩病那种程度的痛苦，但确实有关于它对该病有效的研究。
jamal-kumar查看英文原文
I had really bad IBS from consuming water on a tropical island in Panama one time and suffered for a few years with even my doctor friend telling me "Damn that sucks, not much you can do except manage". Pretty horrible symptoms until I discovered L. Reuteri. [1] I read that it's been a bacteria that was more commonly found in samples until around the 1950s when people started consuming more garbage processed food and was sold. Simply stated, it changed my life. It emits a substance called Reuterin which inhibits the growth of other more harmful bacterial species. [2] I can't speak personally for suffering on the level of Crohn's disease, but there's positive research out there regarding it. [3] [4] [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917019/ [2] https://en.wikipedia.org/wiki/Reuterin [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270012/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468961/
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