Hospital Clınic, Barcelona, Spain.
Aliment Pharmacol Ther. 2013 Oct;38(7):752-60. doi: 10.1111/apt.12440. Epub 2013 Aug 26.
Recently, the notion that smoking may adversely affect Crohn's disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti-TNF drugs might offset the adverse effects of tobacco.
To reassess the influence of tobacco smoking on disease phenotype and complications on a time-dependent analysis, taking into account the different therapeutic interventions.
We designed a retrospective cohort study of 3224 patients with Crohn's disease. The data were collected from the Spanish national inflammatory bowel disease registry (ENEIDA), including information regarding demographics, clinical characteristics, disease complications, therapeutic interventions and smoking status. Patients were classified as nonsmokers, smokers and former smokers, according to their present and past smoking habits.
In the univariate analysis, smokers had more strictures (22.6% vs. 19.3%, P < 0.05) and less colonic involvement (7.2% vs. 10.9%, P < 0.05), and were more frequently under treatment with steroids (91.6% vs. 85.8%, P < 0.05), immunosuppressants (73.5% vs. 63.6% P < 0.05) or anti-TNF drugs (31.4% vs. 25.1%, P < 0.05) than nonsmokers. In the time-dependent multivariate analysis, smokers were found to have a significantly decreased survival free of stricturing disease (HR: 1.5, CI 95% 1.18-1.90) or perianal complications (HR: 1.50, CI 95% 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR: 1.20, CI 95% 1.05-1.30).
These results suggest that, despite the widespread use of immunosuppressants and anti-TNF drugs, smokers with Crohn's disease still have a more severe disease course, with increased therapeutic requirements when compared with nonsmokers.
最近，有人提出，广泛使用免疫抑制剂和抗 TNF 药物可能会抵消烟草的不良影响，从而对吸烟可能会对克罗恩病（CD）结局产生不利影响的观点提出了挑战。
在考虑不同治疗干预措施的情况下，重新评估吸烟对疾病表型和并发症的影响，进行时间依赖性分析。
我们设计了一项回顾性队列研究，纳入了 3224 例克罗恩病患者。数据来自西班牙国家炎症性肠病登记处（ENEIDA），包括人口统计学、临床特征、疾病并发症、治疗干预措施和吸烟状况等信息。根据目前和过去的吸烟习惯，患者被分为非吸烟者、吸烟者和曾经吸烟者。
在单因素分析中，吸烟者发生狭窄的比例更高（22.6% vs. 19.3%，P < 0.05），结肠受累的比例更低（7.2% vs. 10.9%，P < 0.05），且更常接受皮质类固醇（91.6% vs. 85.8%，P < 0.05）、免疫抑制剂（73.5% vs. 63.6%，P < 0.05）或抗 TNF 药物（31.4% vs. 25.1%，P < 0.05）治疗。在时间依赖性多因素分析中，吸烟者无狭窄性疾病生存（HR：1.5，95%CI 1.18-1.90）或肛周并发症（HR：1.50，95%CI 1.01-1.46）的生存时间显著缩短，且需要硫唑嘌呤治疗的风险更高（HR：1.20，95%CI 1.05-1.30）。
尽管广泛使用免疫抑制剂和抗 TNF 药物，但与非吸烟者相比，吸烟的克罗恩病患者的疾病严重程度仍然更严重，治疗需求更高。
