当前吸烟仍是炎症性肠病的一个重要环境因素吗？基于人群的发病队列研究结果。

Is current smoking still an important environmental factor in inflammatory bowel diseases? Results from a population-based incident cohort.

机构信息

1st Department of Medicine, Semmelweis University, Budapest, Hungary.

出版信息

Inflamm Bowel Dis. 2013 Apr;19(5):1010-7. doi: 10.1097/MIB.0b013e3182802b3e.

DOI:10.1097/MIB.0b013e3182802b3e

PMID:23399739

Abstract

BACKGROUND

Previous studies suggest that smoking is an important environmental factor in inflammatory bowel diseases (IBDs), with dichotomous effects in ulcerative colitis (UC) and Crohn's disease (CD). The aim of this study was to analyze the relationship between smoking and IBD risk in a population-based database from Veszprem Province, which included incident cases diagnosed between January 1, 1977, and December 31, 2008.

METHODS

Data from 1420 incident patients were analyzed (UC: 914, age at diagnosis: 38.9 years; CD: 506, age at diagnosis: 31.5 years). Both inpatient and outpatient records were collected and comprehensively reviewed. Overall, smoking frequency in the adult general population was 36.1%.

RESULTS

Of patients with CD, 47.2% were current smokers at diagnosis. Smoking was more frequent in male patients (P = 0.002) and was associated with an increased risk of CD (odds ratio, 1.96; 95% confidence interval, 1.63-2.37; P < 0.001). In contrast, current smoking was protective against UC (odds ratio, 0.33; 95% confidence interval, 0.27-0.41). The effect of smoking was linked to gender (in CD, more deleterious in male patients) and age at diagnosis and was most prominent in young adults, with a difference already being seen in 18- to 19-year-olds. In CD, a change in disease behavior (P = 0.02), location from ileal or colonic to ileocolonic (P = 0.003), arthritis/arthropathy (P = 0.002), need for steroids (P = 0.06), or AZA (P = 0.038) was more common in current smokers. Smoking in UC was associated with more extensive disease (P = 0.01) and a tendency for decreased need for colectomy (P = 0.06).

CONCLUSIONS

Current smoking was associated with the risk of IBD. This effect was linked to gender and age at diagnosis and was most prominent in young adults. No association was observed in pediatric or elderly patients. The deleterious and protective effects of smoking on the course in CD and UC were partially confirmed.

摘要

背景

先前的研究表明，吸烟是炎症性肠病（IBD）的一个重要环境因素，在溃疡性结肠炎（UC）和克罗恩病（CD）中具有双重作用。本研究旨在分析维塞格普雷姆省人群数据库中吸烟与 IBD 风险之间的关系，该数据库包含 1977 年 1 月 1 日至 2008 年 12 月 31 日期间诊断的发病病例。

方法

对 1420 名发病患者的数据进行了分析（UC：914 例，诊断时年龄为 38.9 岁；CD：506 例，诊断时年龄为 31.5 岁）。收集并全面审查了住院和门诊记录。总体而言，成年普通人群的吸烟频率为 36.1%。

结果

CD 患者中有 47.2%在诊断时为现吸烟患者。男性患者吸烟更为频繁（P=0.002），且 CD 发病风险增加（比值比，1.96；95%置信区间，1.63-2.37；P<0.001）。相反，现吸烟对 UC 有保护作用（比值比，0.33；95%置信区间，0.27-0.41）。吸烟的影响与性别（在 CD 中，男性患者的影响更严重）和诊断时的年龄有关，在年轻成年人中最为明显，18-19 岁的患者中已经存在差异。在 CD 中，疾病行为的改变（P=0.02）、病变从回肠或结肠到回结肠（P=0.003）、关节炎/关节病（P=0.002）、需要使用皮质类固醇（P=0.06）或 AZA（P=0.038）在现吸烟者中更为常见。UC 中的吸烟与疾病更广泛（P=0.01）和降低结肠切除术需求的趋势有关（P=0.06）。