From the Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark.
Epidemiology. 2019 Mar;30(2):256-262. doi: 10.1097/EDE.0000000000000946.
The possible etiologic link between tonsillectomy and inflammatory bowel diseases remains unclear. To investigate the hereditary component, we assessed the risk of inflammatory bowel disease after own tonsillectomy as well as after tonsillectomy among family members.
A nationwide Danish cohort of 7,045,288 individuals was established and linked to comprehensive national registers with data on kinship, tonsillectomy surgery, and diagnosis of inflammatory bowel disease from all health sectors. We used Poisson regression models to estimate hospital contact rate ratios (RR) for Crohn's disease and ulcerative colitis, with 95% confidence intervals (CI), between individuals with or without tonsillectomy, as well as between individuals with or without tonsillectomized relatives.
During 189 million person-years of follow-up between 1977 and 2014, 276,673 individuals were tonsillectomized, 22,015 developed Crohn's disease, and 49,550 developed ulcerative colitis. Rates of inflammatory bowel disease were elevated up to 20 years after own tonsillectomy (Crohn's disease: RR 1.52 [95% CI = 1.43, 1.61]; ulcerative colitis: RR 1.24 [95% CI = 1.18, 1.29]). RRs for Crohn's disease was 1.22 (95% CI = 1.17, 1.27) after first-degree relatives' tonsillectomy, 1.14 (95% CI = 1.08, 1.19) after second-degree relatives' tonsillectomy, and 1.08 (95% CI = 1.01, 1.15) after third-degree relatives' tonsillectomy. Corresponding RRs for ulcerative colitis were 1.10 (95% CI = 1.07, 1.13), 1.05 (95% CI = 1.01, 1.08), and 1.03 (95% CI = 0.98, 1.09).
Even individuals with tonsillectomized family members were at increased risk of inflammatory bowel disease. These findings call into question a direct influence of tonsillectomy on gastrointestinal inflammation and point instead toward shared hereditary or environmental factors. See video abstract at, http://links.lww.com/EDE/B464.
扁桃体切除术与炎症性肠病之间可能存在病因联系，但仍不清楚。为了研究遗传因素，我们评估了个体自身行扁桃体切除术以及亲属行扁桃体切除术与炎症性肠病风险的相关性。
我们建立了一个包含 7045288 人的全国性丹麦队列，并与综合国家登记处相关联，这些登记处包含来自所有卫生部门的亲属关系、扁桃体切除术手术和炎症性肠病诊断数据。我们使用泊松回归模型来估计个体接受扁桃体切除术或有接受扁桃体切除术的亲属与未接受扁桃体切除术的个体相比，克罗恩病和溃疡性结肠炎的医院就诊率比值（RR），置信区间（CI）为 95%。
在 1977 年至 2014 年期间的 1.89 亿人年随访中，有 276673 人接受了扁桃体切除术，22015 人患克罗恩病，49550 人患溃疡性结肠炎。在自身接受扁桃体切除术之后的 20 年内，炎症性肠病的发病率升高（克罗恩病：RR 1.52[95%CI=1.43,1.61]；溃疡性结肠炎：RR 1.24[95%CI=1.18,1.29]）。一级亲属行扁桃体切除术的克罗恩病 RR 为 1.22（95%CI=1.17,1.27），二级亲属行扁桃体切除术的 RR 为 1.14（95%CI=1.08,1.19），三级亲属行扁桃体切除术的 RR 为 1.08（95%CI=1.01,1.15）。溃疡性结肠炎的相应 RR 为 1.10（95%CI=1.07,1.13）、1.05（95%CI=1.01,1.08）和 1.03（95%CI=0.98,1.09）。
即使个体有接受过扁桃体切除术的亲属，其发生炎症性肠病的风险也会增加。这些发现对扁桃体切除术直接影响胃肠道炎症提出了质疑，而是指向共同的遗传或环境因素。观看视频摘要，网址为：http://links.lww.com/EDE/B464。
