Feeney Mark A, Murphy Frank, Clegg Andrew J, Trebble Timothy M, Sharer Nicholas M, Snook Jonathon A
Gastroenterology Unit, Poole Hospital, Poole, Dorset.
Eur J Gastroenterol Hepatol. 2002 May;14(5):529-34. doi: 10.1097/00042737-200205000-00010.
To clarify the relationship between childhood environment and the risk of subsequent development of Crohn's disease or ulcerative colitis.
A case-control study, assessing the risk of inflammatory bowel disease in relation to a series of historical and serological markers of childhood circumstance, analysed using the maximum likelihood form of conditional logistic regression.
District general hospital (secondary care institution).
Subjects with Crohn's disease (n = 139) or ulcerative colitis (n = 137) aged between 16 and 45 years, each matched for sex and age with an outpatient control.
Helicobacter seroprevalence was substantially reduced in Crohn's disease (OR 0.18; 95% CI, 0.06-0.52) but not in ulcerative colitis (OR 0.91; 95% CI, 0.38-2.16). In ulcerative colitis, a strong negative association with childhood appendectomy was confirmed (OR 0.05; 95% CI, 0.01-0.51). Crohn's disease was associated with childhood eczema (OR 2.81; 95% CI, 1.23-6.42) and the frequent use of a swimming pool (OR 2.90; 95% CI 1.21-6.91). There was no association between hepatitis A seroprevalence and either disease.
The findings are consistent with the hypothesis that improved childhood living conditions are associated with increased risk of Crohn's disease. The study confirms that the negative association between appendectomy and ulcerative colitis relates primarily to events in childhood. Overall, the findings strongly support the assertion that childhood environment is an important determinant of the risk of inflammatory bowel disease in later life, with quite distinct risk factors for ulcerative colitis and Crohn's disease.
阐明儿童期环境与随后发生克罗恩病或溃疡性结肠炎风险之间的关系。
一项病例对照研究，评估与一系列儿童期情况的历史和血清学标志物相关的炎症性肠病风险，采用条件逻辑回归的最大似然形式进行分析。
地区综合医院（二级医疗机构）。
年龄在16至45岁之间的克罗恩病患者（n = 139）或溃疡性结肠炎患者（n = 137），每组均按性别和年龄与一名门诊对照进行匹配。
克罗恩病患者中幽门螺杆菌血清阳性率大幅降低（比值比0.18；95%置信区间，0.06 - 0.52），但溃疡性结肠炎患者中未降低（比值比0.91；95%置信区间，0.38 - 2.16）。在溃疡性结肠炎中，证实与儿童期阑尾切除术呈强烈负相关（比值比0.05；95%置信区间，0.01 - 0.51）。克罗恩病与儿童期湿疹（比值比2.81；95%置信区间，1.23 - 6.42）以及频繁使用游泳池（比值比2.90；95%置信区间1.21 - 6.91）相关。甲型肝炎血清阳性率与这两种疾病均无关联。
研究结果与以下假设一致，即儿童期生活条件改善与克罗恩病风险增加相关。该研究证实阑尾切除术与溃疡性结肠炎之间的负相关主要与儿童期事件有关。总体而言，研究结果有力支持了以下观点，即儿童期环境是晚年炎症性肠病风险的重要决定因素，溃疡性结肠炎和克罗恩病有截然不同的风险因素。
