慢性阻塞性肺疾病与食管炎、巴雷特食管和食管腺癌的风险：一项初级保健病例对照研究。

Chronic Obstructive Pulmonary Disease and the Risk of Esophagitis, Barrett's Esophagus, and Esophageal Adenocarcinoma: A Primary Care Case-Control Study.

机构信息

The Royal Wolverhampton NHS Trust, Wolverhampton.

Wolfson Computer Laboratories, Queen Elizabeth Hospital, Birmingham.

出版信息

J Clin Gastroenterol. 2019 Nov/Dec;53(10):e451-e455. doi: 10.1097/MCG.0000000000001215.

DOI:10.1097/MCG.0000000000001215

PMID:31008868

Abstract

BACKGROUND

Chronic gastroesophageal reflux predisposes to the development of esophageal adenocarcinoma (EAC). Asthma and medication to treat it are associated with gastroesophageal reflux and EAC. We studied subjects with chronic obstructive pulmonary disease (COPD) to examine the relationship between COPD and medication used to treat it, and the risk of reflux esophagitis, Barrett's esophagus, and EAC.

METHODS

A case-control study from the UK General Practice Research Database was conducted. Cases were aged 50 or above with a diagnosis of COPD and were matched with controls without a diagnosis of COPD by age, general practitioners practice, and time on the database. EAC was confirmed by cross-referencing cancer registry data. Cox-regression analysis was performed to assess the relationship between COPD, reflux esophagitis, Barrett's esophagus, and EAC.

RESULTS

A total of 45,141 cases were studied [24,464 male, age 75 (50 to 100) years]. Among COPD cases there were 55 esophageal cancers (30 EAC) and 506 Barrett's esophagus, compared with 62 (34 EAC) and 329 Barrett's esophagus among controls. COPD was not associated with EAC on univariable [0.92 (0.56 to 1.50), P=0.73] and multivariable analysis [0.85 (0.52 to 1.40), P=0.53]. COPD was however, associated with Barrett's esophagus on univariable [0.92 (0.56 to 1.50), P=0.73] and multivariable [1.53 (1.31 to 1.78), P<0.001] analysis and reflux esophagitis on univariable [1.41 (1.36 to 1.48), P<0.001] and multivariable [1.33 (1.27 to 1.40), P<0.001] analysis.

CONCLUSION

COPD is associated with an increased risk of reflux esophagitis and Barrett's esophagus but not EAC.

摘要

背景

慢性胃食管反流病易导致食管腺癌（EAC）的发生。哮喘和治疗哮喘的药物与胃食管反流病和 EAC 有关。我们研究了慢性阻塞性肺疾病（COPD）患者，以研究 COPD 及其治疗药物与反流性食管炎、巴雷特食管和 EAC 风险之间的关系。

方法

这是一项来自英国全科医学研究数据库的病例对照研究。病例组为年龄在 50 岁及以上、确诊为 COPD 的患者，通过年龄、全科医生的实践和数据库中的时间与未确诊为 COPD 的对照组相匹配。通过交叉参考癌症登记数据来确认 EAC。采用 Cox 回归分析评估 COPD、反流性食管炎、巴雷特食管和 EAC 之间的关系。

结果

共纳入 45141 例患者[24464 例男性，年龄 75（50 至 100）岁]。在 COPD 患者中，有 55 例食管癌（30 例 EAC）和 506 例巴雷特食管，而对照组分别有 62 例（34 例 EAC）和 329 例巴雷特食管。单变量分析时，COPD 与 EAC 无关[0.92（0.56 至 1.50），P=0.73]，多变量分析时也无关[0.85（0.52 至 1.40），P=0.53]。然而，单变量分析时，COPD 与巴雷特食管有关[0.92（0.56 至 1.50），P=0.73]，多变量分析时也有关[1.53（1.31 至 1.78），P<0.001]，与反流性食管炎也有关，单变量分析时[1.41（1.36 至 1.48），P<0.001]，多变量分析时[1.33（1.27 至 1.40），P<0.001]。