Bernstein Charles N, Rawsthorne Patricia, Cheang Mary, Blanchard James F
University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada.
Am J Gastroenterol. 2006 May;101(5):993-1002. doi: 10.1111/j.1572-0241.2006.00381.x.
We aimed to pursue potential etiological clues to Crohn's disease (CD) and ulcerative colitis (UC) through a population-based case control survey study.
Cases with CD (n = 364) and UC (n = 217), ages 18-50 yr were drawn from the population-based University of Manitoba IBD Research Registry. Potential control subjects were drawn from the population-based Manitoba Health Registry by age, gender, and geographic residence matching to the cases (n = 433). Subjects were administered a multiitem questionnaire.
By univariate analysis, some of the variables predictive of CD included lower likelihood of living on a farm, of having drunk unpasteurized milk or having eaten pork, and UC patients were less likely to have drunk unpasteurized milk and to have eaten pork. On multivariate analysis, variables significantly associated with CD were being Jewish (OR = 4.32, 95% CI 1.10-16.9), having a first degree relative with IBD (OR = 3.07, 95% CI 1.73-5.46), ever having smoked (OR = 1.54, 95% CI, 1.06-2.25), living longer with a smoker (OR = 1.03, 95% CI, 1.01-1.04). Being a first generation Canadian (OR = 0.33, 95% CI, 0.17-0.62), having pet cats before age 5 (OR = 0.66, 95% CI, 0.46-0.96) and having larger families (OR = 0.87, 95% CI, 0.79-0.96) were protective against CD. For UC being Jewish (OR = 7.46, 95% CI, 2.33-23.89), having a relative with IBD (OR = 2.23, 95% CI, 1.27-3.9), and ever smoking (OR = 1.62, 95% CI, 1.14-2.32) were predictive.
This study reinforced the increased risk associated with family history, being Jewish, and smoking history, however, a number of significant associations with CD and UC on univariate and multivariate analysis may support the "hygiene hypothesis" and warrant further exploration in prospective studies.
我们旨在通过一项基于人群的病例对照研究探寻克罗恩病（CD）和溃疡性结肠炎（UC）的潜在病因线索。
从基于人群的曼尼托巴大学炎症性肠病研究登记处选取年龄在18至50岁之间的CD患者（n = 364）和UC患者（n = 217）。潜在对照对象通过年龄、性别和地理居住情况与病例匹配，从基于人群的曼尼托巴健康登记处选取（n = 433）。对研究对象进行多项目问卷调查。
单因素分析显示，一些预测CD的变量包括居住在农场的可能性较低、饮用生牛奶或食用猪肉的可能性较低，而UC患者饮用生牛奶和食用猪肉的可能性较小。多因素分析表明，与CD显著相关的变量包括为犹太人（OR = 4.32，95%CI 1.10 - 16.9）、有一级亲属患炎症性肠病（OR = 3.07，95%CI 1.73 - 5.46）、曾经吸烟（OR = 1.54，95%CI 1.06 - 2.25）、与吸烟者长期共同生活（OR = 1.03，95%CI 1.01 - 1.04）。作为第一代加拿大移民（OR = 0.33，95%CI 0.17 - 0.62）、5岁前养猫（OR = 0.66，95%CI 0.46 - 0.96）以及家庭规模较大（OR = 0.87，95%CI 0.79 - 0.96）对CD具有保护作用。对于UC，为犹太人（OR = 7.46，95%CI 2.33 - 23.89）、有亲属患炎症性肠病（OR = 2.23，95%CI 1.27 - 3.9）以及曾经吸烟（OR = 1.62，95%CI 1.14 - 2.32）具有预测性。
本研究强化了家族史、犹太血统和吸烟史与患病风险增加之间的关联，然而，单因素和多因素分析中一些与CD和UC的显著关联可能支持“卫生假说”，值得在前瞻性研究中进一步探索。
