Kiyohara Chikako, Kusuhara Shota
Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
Fukuoka Igaku Zasshi. 2011 Aug;102(8):254-65.
Many but not all studies have indicated that smoking is inversely associated with Parkinson's disease (PD). Meta-analysis of epidemiological studies on smoking and PD was performed to summarize data from published studies. Fifty-four epidemiological studies (48 case-control and 6 cohort studies, 53 publications) were identified for potential inclusion in meta-analysis. The summary risk estimates for current smokers, former smokers, and ever (current and former) smokers were 0.31 (95% confidence interval (CI) = 0.25-0.38), 0.72 (95% CI = 0.63-0.83) and 0.55 (95% CI = 0.51-0.59), respectively. In stratified analysis by study design, smoking had a somewhat greater impact on PD risk in cohort studies than in case-control studies. However, meta-regression indicated that the study design did not significantly contribute to heterogeneity. Additional analyses were restricted to case-control studies because of the sufficient number of studies. Stratified analysis by ethnicity indicated that the summary OR for ever-smokers was nonsignificantly smaller in Asian populations than in Caucasian populations. In stratified analysis by source of controls, former smoking was significantly associated with a decreased risk of PD in hospital-based case-control studies but was marginally associated with a decreased risk in population-based case-control studies. The source of controls did not contribute significantly to heterogeneity. PD risk associated with ever-smoking was significantly lower for a hospital-based approach than a population-based approach. Among current smokers, the association held true to the same extent for both approaches. This meta-analysis indicated that smokers have a lower risk of PD. As PD is a multifactorial disease, further investigation of the smoking-gene interaction on PD risk may lead to a better understanding of the pathogenesis of PD.
许多但并非所有研究表明，吸烟与帕金森病（PD）呈负相关。对吸烟与PD的流行病学研究进行了荟萃分析，以总结已发表研究的数据。确定了54项流行病学研究（48项病例对照研究和6项队列研究，53篇出版物）可能纳入荟萃分析。当前吸烟者、既往吸烟者和曾经（当前和既往）吸烟者的汇总风险估计分别为0.31（95%置信区间（CI）=0.25 - 0.38）、0.72（95%CI = 0.63 - 0.83）和0.55（95%CI = 0.51 - 0.59）。在按研究设计进行的分层分析中，吸烟对队列研究中PD风险的影响比对病例对照研究的影响稍大。然而，荟萃回归表明研究设计对异质性的贡献不显著。由于研究数量充足，额外分析仅限于病例对照研究。按种族进行的分层分析表明，亚洲人群中曾经吸烟者的汇总比值比（OR）略低于白种人群，但差异无统计学意义。在按对照来源进行的分层分析中，既往吸烟在基于医院的病例对照研究中与PD风险降低显著相关，但在基于人群的病例对照研究中与风险降低的相关性较弱。对照来源对异质性的贡献不显著。与曾经吸烟相关的PD风险在基于医院和基于人群的研究方法中存在显著差异，基于医院的方法风险更低。在当前吸烟者中，两种方法的关联程度相同。这项荟萃分析表明吸烟者患PD的风险较低。由于PD是一种多因素疾病，进一步研究吸烟与基因相互作用对PD风险的影响可能有助于更好地理解PD的发病机制。
