炎症性肠病环境风险因素：基于人群的中东移民移居澳大利亚的病例对照研究。
Inflammatory Bowel Disease Environmental Risk Factors: A Population-Based Case-Control Study of Middle Eastern Migration to Australia.
机构信息
Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia; Gastroenterology and Liver Services, Bankstown Hospital, Sydney, Australia; Faculty of Medicine, UNSW Australia.
Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia; Gastroenterology and Liver Services, Bankstown Hospital, Sydney, Australia.
出版信息
Clin Gastroenterol Hepatol. 2015 Aug;13(8):1453-63.e1. doi: 10.1016/j.cgh.2015.02.045. Epub 2015 Mar 11.
BACKGROUND & AIMS: The incidences of the inflammatory bowel diseases (IBDs) Crohn's disease (CD) and ulcerative colitis (UC) are increasing, indicating gene-environment interactions. Migrants from low-IBD-prevalence countries to a high-prevalence country may help identify the relative contribution of environmental risk factors compared with native Caucasians.
METHODS
This prospective case-control study evaluated IBD environmental risk factors of Middle Eastern migrants (MEM) in Australia compared with matched Caucasian IBD subjects, MEM controls, Caucasian controls, and controls in the Middle East using adjusted odds ratios (aOR).
RESULTS
A total of 795 subjects were recruited: 154 MEM cases (75 CD; 79 UC), 153 MEM controls, 162 Caucasian cases (85 CD; 77 UC), 173 Caucasian controls, and 153 controls in Lebanon. Smoking increased CD risk in MEM and Caucasians and reduced UC risk in Caucasians (aOR, 0.77; 95% CI, 0.41-0.98) but not MEM (aOR, 1.45; 95% CI, 0.80-2.62). Antibiotic use reduced the risk of MEM CD (aOR, 0.27; 95% CI, 0.11-0.67) and UC (aOR, 0.38; 95% CI, 0.18-0.80), but increased the risk in Caucasians (CD: aOR, 5.24; 95% CI, 2.13-12.90; and UC: aOR, 6.82; 95% CI, 2.67-17.38). Most hygiene markers (rural dwelling, pet ownership, pet feeding, and farm animal contact) reduced CD and UC risk in MEM (P < .05). In contrast, in Caucasians these hygiene markers lacked significance. Other significant risk factors include IBD family history, appendectomy, tonsillectomy, and breastfeeding.
CONCLUSIONS
Differential IBD environmental risk factors exist between migrants and native Caucasians, indicating a dynamic interplay between environmental factors and IBD risk for immigrants that is distinct to those factors most relevant in native Caucasians.
背景与目的
炎症性肠病（IBD）的发病率不断上升，包括克罗恩病（CD）和溃疡性结肠炎（UC），这表明存在基因-环境相互作用。来自低 IBD 发病率国家的移民到高发病率国家，可能有助于确定与当地白种人相比，环境危险因素的相对贡献。
方法
本前瞻性病例对照研究评估了澳大利亚中东移民（MEM）的 IBD 环境危险因素，与匹配的白种人 IBD 患者、MEM 对照组、白种人对照组以及中东对照组进行比较，采用调整后的优势比（aOR）。
结果
共招募了 795 名受试者：154 名 MEM 病例（75 名 CD；79 名 UC），153 名 MEM 对照组，162 名白种人病例（85 名 CD；77 名 UC），173 名白种人对照组和 153 名黎巴嫩对照组。吸烟增加了 MEM 和白种人 CD 的发病风险，降低了白种人 UC 的发病风险（aOR，0.77；95%CI，0.41-0.98），但对 MEM 没有影响（aOR，1.45；95%CI，0.80-2.62）。抗生素的使用降低了 MEM CD（aOR，0.27；95%CI，0.11-0.67）和 UC（aOR，0.38；95%CI，0.18-0.80）的发病风险，但增加了白种人 CD（aOR，5.24；95%CI，2.13-12.90）和 UC（aOR，6.82；95%CI，2.67-17.38）的发病风险。大多数卫生标志物（农村居住、宠物饲养、宠物喂养和农场动物接触）降低了 MEM 的 CD 和 UC 发病风险（P <.05）。相比之下，在白种人中，这些卫生标志物则没有显著意义。其他显著的危险因素包括 IBD 家族史、阑尾切除术、扁桃体切除术和母乳喂养。
结论
移民和本地白种人之间存在不同的 IBD 环境危险因素，这表明环境因素与移民的 IBD 风险之间存在动态相互作用，这种作用与在本地白种人中最相关的因素明显不同。
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