Seksik Philippe, Nion-Larmurier Isabelle, Sokol Harry, Beaugerie Laurent, Cosnes Jacques
Gastroenterology & Nutrition Department, Hôpital Saint-Antoine & Université Pierre et Marie Curie, Paris VI, AP-HP, Paris, France.
Inflamm Bowel Dis. 2009 May;15(5):734-41. doi: 10.1002/ibd.20828.
Cigarette smoking is associated with a more severe Crohn's disease (CD) course. However, the effect of light consumption is not known. Our aim was to characterize the effect of a light tobacco consumption on the course of CD.
We analyzed the course of CD during the period 1995-2007 from data collected in 2795 consecutive patients in whom smoking habits were recorded. Patients were classified as nonsmokers (n = 1420), light smokers (1-10 cigarettes/day; n = 385), heavy smokers (>10 cigarettes/day; n = 638), and intermittent smokers (change in smoking habits; n = 352). Patient-years while smoking were compared to patient-years without smoking. The analyses considered patient-years regarding annual disease activity and therapeutic requirements.
The percentage of years with active disease was 37% in nonsmokers versus 46% in light smokers (P < 0.001; adjusted hazard ratio 1.30 [1.19-1.43]) and 48% in heavy smokers (P < 0.001; adjusted hazard ratio 1.68 [1.57-1.81]), despite an increased use of immunosuppressants in smokers. Hospitalization rates were also increased in both groups of smokers, with 12% in nonsmokers versus 15% in both groups of smokers (P < 0.001 for both comparisons). The annual rate of intestinal resection was 4.5% in nonsmokers, 5.1% in light smokers, and 5.5% in heavy smokers, with a significant difference observed between nonsmokers and heavy smokers only (P < 0.01).
Light smokers are doing worse than nonsmokers regarding disease activity and the need for immunosuppressants. Complete smoking cessation should be advised in all smokers with CD.
吸烟与克罗恩病（CD）病情更严重相关。然而，轻度吸烟的影响尚不清楚。我们的目的是描述轻度吸烟对CD病程的影响。
我们分析了1995年至2007年期间连续收集的2795例记录了吸烟习惯的患者的CD病程。患者分为非吸烟者（n = 1420）、轻度吸烟者（每天1 - 10支香烟；n = 385）、重度吸烟者（每天>10支香烟；n = 638）和间歇性吸烟者（吸烟习惯改变；n = 352）。将吸烟时的患者年数与不吸烟时的患者年数进行比较。分析考虑了与年度疾病活动和治疗需求相关的患者年数。
非吸烟者疾病活动年的百分比为37%，轻度吸烟者为46%（P < 0.001；调整后的风险比为1.30 [1.19 - 1.43]），重度吸烟者为48%（P < 0.001；调整后的风险比为1.68 [1.57 - 1.81]），尽管吸烟者使用免疫抑制剂的比例有所增加。两组吸烟者的住院率也有所上升，非吸烟者为12%，两组吸烟者均为15%（两项比较P均< 0.001）。非吸烟者的肠道切除年率为4.5%，轻度吸烟者为5.1%，重度吸烟者为5.5%，仅非吸烟者与重度吸烟者之间存在显著差异（P < 0.01）。
就疾病活动和免疫抑制剂需求而言，轻度吸烟者比非吸烟者情况更差。建议所有患有CD的吸烟者完全戒烟。
