Centre for Inflammatory Bowel Diseases, Fremantle Hospital, WA, Australia; University Department of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, WA, Australia.
J Crohns Colitis. 2013 Dec;7(12):e665-71. doi: 10.1016/j.crohns.2013.05.007. Epub 2013 Jun 20.
Smoking increases CD risk. The aim was to determine if smoking cessation at, prior to, or following, CD diagnosis affects medication use, disease phenotypic progression and/or surgery.
Data on CD patients with disease for ≥5 yrs were collected retrospectively including the Montreal classification, smoking history, CD-related abdominal surgeries, family history, medication use and disease behaviour at diagnosis and the time when the disease behaviour changed.
1115 patients were included across six sites (mean follow-up-16.6 yrs). More non-smokers were male (p=0.047) with A1 (p<0.0001), L4 (p=0.028) and perianal (p=0.03) disease. Non-smokers more frequently received anti-TNF agents (p=0.049). (p=0.017: OR 2.5 95%CI 1.18-5.16) and those who ceased smoking prior to diagnosis (p=0.045: OR 2.3 95%CI 1.02-5.21) progressed to complicated (B2/B3) disease as compared to those quitting at diagnosis. Patients with uncomplicated terminal ileal disease at diagnosis more frequently developed B2/B3 disease than isolated colonic CD (p<0.0001). B2/B3 disease was more frequent with perianal disease (p<0.0001) and if i.v. steroids (p=0.004) or immunosuppressants (p<0.0001) were used. 49.3% (558/1115) of patients required at least one intestinal surgery. More smokers had a 2nd surgical resection than patients who quit at, or before, the 1st resection and non-smokers (p=0.044: HR=1.39 95%CI 1.01-1.91). Patients smoking >3 cigarettes/day had an increased risk of developing B2/B3 disease (p=0.012: OR 3.8 95%CI 1.27-11.17).
Progression to B2/B3 disease and surgery is reduced by smoking cessation. All CD patients regardless of when they were diagnosed, or how many surgeries, should be strongly encouraged to cease smoking.
吸烟会增加 CD 的风险。本研究旨在确定 CD 诊断前后或之前戒烟是否会影响药物使用、疾病表型进展和/或手术。
回顾性收集了疾病史≥5 年的 CD 患者的数据，包括蒙特利尔分类、吸烟史、CD 相关腹部手术、家族史、诊断时及疾病行为改变时的药物使用和疾病行为。
六个中心共纳入 1115 例患者（平均随访 16.6 年）。非吸烟者中男性更多（p=0.047），A1（p<0.0001）、L4（p=0.028）和肛周（p=0.03）疾病更常见。非吸烟者更常使用抗 TNF 药物（p=0.049）。（p=0.017：OR 2.5 95%CI 1.18-5.16）和戒烟时间早于诊断的患者（p=0.045：OR 2.3 95%CI 1.02-5.21）进展为复杂（B2/B3）疾病。诊断时患有简单末端回肠炎的患者比孤立性结肠 CD 更常发展为 B2/B3 疾病（p<0.0001）。肛周疾病（p<0.0001）、使用静脉注射类固醇（p=0.004）或免疫抑制剂（p<0.0001）时，B2/B3 疾病更常见。1115 例患者中有 49.3%（558/1115）至少进行了一次肠道手术。与戒烟、或在首次手术后戒烟的患者相比，吸烟者有更多人需要进行第二次切除术（p=0.044：HR=1.39 95%CI 1.01-1.91）。每天吸烟>3 支的患者发展为 B2/B3 疾病的风险增加（p=0.012：OR 3.8 95%CI 1.27-11.17）。
戒烟可降低发展为 B2/B3 疾病和手术的风险。无论何时诊断、进行了多少次手术，都应强烈鼓励所有 CD 患者戒烟。
