Munigala Satish, Conwell Darwin L, Gelrud Andres, Agarwal Banke
From the *Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University, St Louis, MO; †Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and ‡Center for Pancreatic Disorders, Division of Gastroenterology, University of Chicago, Chicago, IL.
Pancreas. 2015 Aug;44(6):876-81. doi: 10.1097/MPA.0000000000000364.
There is limited data on cigarette smoking and the risk of acute pancreatitis (AP). We evaluated the influence of cigarette smoking on AP risk and clinical presentation in a large cohort of Veteran's Administration (VA) patients.
Retrospective study of VA patients from 1998 to 2007. Exclusion criteria included (1) history of chronic pancreatitis (n = 3222) or gallstones (n = 14,574) and (2) age younger than 15 years (n = 270). A 2-year washout period was used to exclude patients with pre-existing recurrent AP.
The study included 484,624 patients. From 2001 to 2007, a total of 6799 (1.4%) patients had AP. Alcohol (risk ratio, 4.20) and smoking (risk ratio, 1.78) were independent significant risk factors of AP on multiple regression analysis. Smoking increased the risk of AP in both nonalcoholics (0.57% vs 1.1%) and alcoholics (2.6% vs 4.1%). Smoking was associated with younger mean age at first episode of AP and higher likelihood of recurrent AP (≥4 episodes) in both nonalcoholics and alcoholics. The interval between recurrent episodes was not altered by alcohol or smoking.
In a large cohort of VA patients, smoking is an independent risk factor for AP and augmented the effect of alcohol on the risk, age of onset, and recurrence of AP.
关于吸烟与急性胰腺炎（AP）风险的数据有限。我们在一大群退伍军人事务部（VA）患者中评估了吸烟对AP风险及临床表现的影响。
对1998年至2007年的VA患者进行回顾性研究。排除标准包括：（1）慢性胰腺炎病史（n = 3222）或胆结石病史（n = 14574）；（2）年龄小于15岁（n = 270）。采用2年的洗脱期以排除既往有复发性AP的患者。
该研究纳入了484624例患者。从2001年至2007年，共有6799例（1.4%）患者发生AP。在多元回归分析中，酒精（风险比，4.20）和吸烟（风险比，1.78）是AP的独立显著风险因素。吸烟在非酗酒者（0.57%对1.1%）和酗酒者（2.6%对4.1%）中均增加了AP风险。吸烟与非酗酒者和酗酒者首次发生AP时的平均年龄较轻以及复发性AP（≥4次发作）的可能性较高相关。复发发作之间的间隔不受酒精或吸烟的影响。
在一大群VA患者中，吸烟是AP的独立风险因素，并增强了酒精对AP风险、发病年龄和复发的影响。
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