戒烟对降低护士健康研究中女性类风湿关节炎风险的影响和时机。
Impact and Timing of Smoking Cessation on Reducing Risk of Rheumatoid Arthritis Among Women in the Nurses' Health Studies.
机构信息
Brigham and Women's Hospital, Boston, Massachusetts.
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
出版信息
Arthritis Care Res (Hoboken). 2019 Jul;71(7):914-924. doi: 10.1002/acr.23837.
OBJECTIVE
To investigate the impact and timing of smoking cessation on developing rheumatoid arthritis (RA) and serologic phenotypes.
METHODS
We investigated smoking cessation and RA risk in the Nurses' Health Study (NHS) (1976-2014) and the NHS II (1989-2015). Smoking exposures and covariates were obtained by biennial questionnaires. Self-reported RA was confirmed by medical record review for American College of Rheumatology/European League Against Rheumatism criteria. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for RA serologic phenotypes (all, seropositive, seronegative) according to smoking status, intensity, pack-years, and years since cessation.
RESULTS
Among 230,732 women, we identified 1,528 incident cases of RA (63.4% of which were seropositive) during 6,037,151 person-years of follow-up. Compared with never smoking, current smoking increased the risk of all RA (multivariable HR 1.47, 95% CI 1.27-1.72) and seropositive RA (HR 1.67, 95% CI 1.38-2.01) but not seronegative RA (HR 1.20, 95% CI 0.93-1.55). An increasing number of smoking pack-years was associated with an increased trend for the risk of all RA (P < 0.0001) and seropositive RA (P < 0.0001). With increasing duration of smoking cessation, a decreased trend for the risk of all RA was observed (P = 0.009) and seropositive RA (P = 0.002). Compared to recent quitters (<5 years), those who quit ≥30 years ago had an HR of 0.63 (95% CI 0.44-0.90) for seropositive RA. However, a modestly increased risk of RA was still detectable 30 years after quitting smoking (for all RA, HR 1.25 [95% CI 1.02-1.53]; for seropositive RA, HR 1.30 [95% CI 1.01-1.68]; reference, never smoking).
CONCLUSION
These results confirm that smoking is a strong risk factor for developing seropositive RA and demonstrate for the first time that a behavior change of sustained smoking cessation could delay or even prevent seropositive RA.
目的
研究戒烟对类风湿关节炎（RA）发病和血清学表型的影响及其发生时间。
方法
我们对护士健康研究（NHS）（1976-2014 年）和 NHS II（1989-2015 年）中的戒烟与 RA 风险进行了研究。通过每两年一次的问卷获取吸烟暴露情况和协变量。根据美国风湿病学会/欧洲抗风湿病联盟标准，通过病历复查来确认自报的 RA。采用 Cox 回归估计 RA 血清学表型（所有、阳性、阴性）的风险比（HR）和 95%置信区间（95%CI），并根据吸烟状况、吸烟强度、吸烟包年数和戒烟年限进行分层。
结果
在 230732 名女性中，我们在 6037151 人年的随访期间发现了 1528 例 RA 新发病例（其中 63.4%为阳性）。与从不吸烟相比，当前吸烟增加了所有 RA（多变量 HR 1.47，95%CI 1.27-1.72）和血清阳性 RA（HR 1.67，95%CI 1.38-2.01）的风险，但未增加血清阴性 RA（HR 1.20，95%CI 0.93-1.55）的风险。吸烟包年数的增加与所有 RA（P<0.0001）和血清阳性 RA（P<0.0001）风险呈增加趋势相关。随着戒烟时间的延长，所有 RA（P=0.009）和血清阳性 RA（P=0.002）的风险呈下降趋势。与近期戒烟者（<5 年）相比，戒烟≥30 年者血清阳性 RA 的 HR 为 0.63（95%CI 0.44-0.90）。然而，戒烟 30 年后仍能检测到 RA 风险略有增加（所有 RA，HR 1.25[95%CI 1.02-1.53]；血清阳性 RA，HR 1.30[95%CI 1.01-1.68]；参考值，从不吸烟）。
结论
这些结果证实吸烟是发生血清阳性 RA 的一个强有力的危险因素，并首次表明持续戒烟这一行为改变可以延缓甚至预防血清阳性 RA 的发生。
Zotero 插件