Vazquez H, Smecuol E, Flores D, Mazure R, Pedreira S, Niveloni S, Mauriño E, Bai J C
Small Bowel Section, Clinical Department, Dr. Carlos Bonorino Udaondo, Gastroenterology Hospital, Buenos Aires, Argentina.
Am J Gastroenterol. 2001 Mar;96(3):798-802. doi: 10.1111/j.1572-0241.2001.03625.x.
It has been suggested that environmental factors other than gliadin might play a role in pathogenesis of celiac disease. Cigarette smoking was reported to exert a protective effect against the development of symptomatic celiac disease; however, this relationship was not confirmed. The aim of this study was to determine the effect of cigarette smoking on celiac disease.
A cohort of 87 consecutive celiac disease patients attending the clinic of Malabsorption and 174 age- and sex-matched individuals diagnosed with functional GI disorder were included in the study. Clinical information was obtained both at the time of diagnosis and at follow-up by reviewing the clinical history. Smoking information was obtained through an in-person interview using a questionnaire.
Although 33% of controls were current smokers at the time of the study, only 16% of celiac patients were smokers at diagnosis (odds ratio, 0.39; 95% confidence interval 0.19-0.79; p < 0.006). The proportion of nonsmokers among patients (84%) was significantly greater than that among controls (67%; odds ratio, 2.54; 95% confidence interval 1.27-5.16; p < 0.007). Current smoker patients had a lower baseline BMI (p < 0.05) and body weight (p < 0.05) compared to former smokers. Compared with nonsmokers, control individuals who were active smokers at entry in the study were younger (p < 0.02) and had lower body weight (p < 0.03) and BMI (p < 0.03). Interestingly, positive lineal correlation was observed between age at diagnosis and daily cigarette consumption (r = 0.72; p < 0.004) in active smokers. We did not detect any relationship either between causes for cessation of smoking and clinical symptoms or between differences in the proportions of smoking habits when patients were stratified according to their clinical status at diagnosis (symptomatic vs subclinical/asymptomatic cases).
This study provides evidence that, compared with control subjects, a significantly lower proportion of patients with celiac disease were current smokers at the time of diagnosis, and that cigarette smoking delayed diagnosis of celiac disease. Our study suggests that the nutritional compromise of patients with celiac disease who smoked resulted from the summation of the effect of celiac disease per se and that produced by the smoking habit. Further studies are necessary to identify whether the relationship between smoking and celiac disease is causal or incidental.
有人提出，除麦醇溶蛋白外，环境因素可能在乳糜泻的发病机制中起作用。据报道，吸烟对有症状的乳糜泻的发展具有保护作用；然而，这种关系尚未得到证实。本研究的目的是确定吸烟对乳糜泻的影响。
本研究纳入了87例连续就诊于吸收不良门诊的乳糜泻患者以及174例年龄和性别匹配、被诊断为功能性胃肠疾病的个体。通过回顾临床病史，在诊断时和随访时获取临床信息。吸烟信息通过使用问卷进行面对面访谈获得。
尽管在研究时33%的对照者为当前吸烟者，但只有16%的乳糜泻患者在诊断时吸烟（优势比，0.39；95%置信区间0.19 - 0.79；p < 0.006）。患者中不吸烟者的比例（84%）显著高于对照者（67%；优势比，2.54；95%置信区间1.27 - 5.16；p < 0.007）。与既往吸烟者相比，当前吸烟的患者基线BMI（p < 0.05）和体重（p < 0.05）较低。与不吸烟者相比，研究开始时为现吸烟者的对照个体更年轻（p < 0.02），体重（p < 0.03）和BMI（p < 0.03）更低。有趣的是，在现吸烟者中，诊断时的年龄与每日吸烟量之间存在正线性相关（r = 0.72；p < 0.004）。当根据诊断时的临床状态（有症状与亚临床/无症状病例）对患者进行分层时，我们未发现戒烟原因与临床症状之间或吸烟习惯比例差异之间存在任何关系。
本研究提供的证据表明，与对照受试者相比，乳糜泻患者在诊断时为当前吸烟者的比例显著更低，且吸烟延迟了乳糜泻的诊断。我们的研究表明，吸烟的乳糜泻患者的营养受损是由乳糜泻本身的影响与吸烟习惯产生的影响相加所致。有必要进一步研究以确定吸烟与乳糜泻之间的关系是因果关系还是偶然关系。
