母乳維生素A和D含量與嬰兒異位性皮膚炎關聯性之探討

異位性皮膚炎 (atopic dermatitis, atopic eczema) 為常見過敏性皮膚炎疾病，全球約有15-20%孩童及1-3%成人罹患此病。近年來免疫相關疾病的研究指出，飲食為異位性皮膚炎罹患風險及嚴重程度的影響因子。維生素A與D具有免疫調節作用，國人維生素A與D攝取有缺乏之虞，維生素A與D的營養狀況與過敏疾病發生率是否有關聯性，值得探討。已知哺乳能降低嬰兒異位性皮膚炎罹患率，然而近年門診發現異位性皮膚炎嬰兒也多有哺餵母乳，因此，推測是否與母乳的營養成分有關。故本研究目的為探討嬰兒異位性皮膚炎是否與母乳的營養素的含量有關，尤其是維生素A和D3。本研究與台大醫院小兒科過敏門診合作，收募受試者為六個月齡以下異位性皮膚炎嬰兒48位為病例組，健康嬰兒47位作為控制組，測定母親之母乳的 retinol、25-hydroxyvitamin D3 (25-(OH) D3) 及細胞激素含量，並對母親進行一個月的飲食頻率問卷調查。結果顯示，母親的鉀、鋅、維生素B1、菸鹼素、維生素B6及酒精攝取量，與嬰兒的SCORAD呈顯著正相關。中重度AD組的母親熱量攝取較health組少，與輕度AD組相比，母親的鋅、維生素B1及膽固醇攝取量較高。此外，中重度AD組的母乳25-(OH) D3與TGF-β含量顯著低於health組，而母乳retinol含量有較輕度AD組低的趨勢。綜合以上，六個月齡以下嬰兒所攝取母乳的維生素D及TGF-β含量越少，可能增加嬰兒罹患異位性皮膚炎的風險及嚴重程度。

關鍵字

異位性皮膚炎；母乳；維生素A ；維生素D ； TGF-β ；母親飲食

並列摘要

Atopic dermatitis, also known as atopic eczema, is a common allergic skin disease. There are 15-20% children and 1-3% adults suffer from atopic dermatitis all over the world. Some studies showed that diet affects the risk and severity of atopic dermatitis. It had been known that vitamin A and D regulate immune response. There are high proportion of people have the status of vitamin A and D deficiency in Taiwan, while the correlation between the vitamins and incidences of allergic diseases is still unclear. Also, studies had showed that breastfeeding can lower the risk of atopic dermatitis. However, there are many breastfed infants suffer from atopic dermatitis nowadays, we hypothesize that breast milk nutrition might affect the morbidity rate and severe of atopic dermatitis. Therefore, the aim of this research is to investigate the association between human breast milk vitamin levels and atopic dermatitis status. We cooperate with the department of the pediatric allergy at NTU hospital. There are 48 infants with atopic dermatitis and 47 health infants who are under 6-months of age participated in this research, we collected breast milk from all infants’ mothers to detect retinol, 25-hydroxyvitamin D3 (25-(OH) D3) and cytokine levels, and we also analyzed maternal diet by FFQ (food frequency questionnaire). Results showed that the correlation between K, Zn, vitamin B1, niacin or alcohol from maternal diet in AD group and SCORAD (SCORing Atopic Dermatitis) were significantly positive. The moderate-AD group took less energy than the health group did, but it took more in Zn, vitamin B1 and cholesterol than the mild-AD group did. In addition, breast milk 25-(OH) D3 and TGF-β levels in the moderate-AD group were significantly lower than they were in the health group. We also found that breast milk retinol levels in the moderate-AD group were lower than they were in the mild-AD group. In conclusion, if the infants under 6 months of age take lower breast milk 25-(OH) D3 and TGF-β, it might increase the risk and severe of atopic dermatitis.