Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Depress Anxiety. 2020 Nov;37(11):1108-1117. doi: 10.1002/da.23045. Epub 2020 Jul 15.
Recent studies suggest that disruption of the colonic microbiota homeostasis is associated with low-grade systemic inflammation and mental disorders. The cecal appendix may influence the homeostasis of the colonic microbiota. In this large population-based study, we investigated whether early removal of the appendix is associated with an increased risk of mental disorders later in life.
All Swedish individuals born between 1973 and 1992 (N = 1,937,488) were included and followed prospectively until December 31, 2016 for any psychiatric International Classification of Disease diagnosis from age 14 or later in life. The main exposure was defined as having a history of appendectomy before age 14 (N = 44,259); the second exposure, appendicitis before age 14 but without appendectomy (N = 1,542), and the third exposure studied was a history of hernia surgery before age 14 (N = 35,523). Control groups for each respective exposure were all unexposed individuals in the study population.
Individuals exposed to appendectomy before age 14 had a 19% increased risk of depressive disorder (adjusted hazard ratio [aHR] = 1.19; 95% confidence interval [95% CI]: 1.15-1.23), 27% increased risk of bipolar affective disorder (aHR = 1.27; 95% CI: 1.17-1.37), and a 20% increased risk of an anxiety disorder (aHR = 1.20; 95% CI: 1.16-1.23) compared to individuals unexposed to childhood appendectomy. We found no association between appendectomy and increased risk of obsessive-compulsive disorder and schizophrenia and there was no association between appendicitis without appendectomy and mental disorders. The association between childhood hernia surgery and mental disorders later in life was small but significant.
Childhood appendectomy, but not appendicitis without appendectomy, was associated with a significantly increased risk of mood and anxiety disorders in adulthood.
最近的研究表明，结肠微生物组稳态的破坏与低度全身炎症和精神障碍有关。盲肠阑尾可能会影响结肠微生物组的稳态。在这项大规模的基于人群的研究中，我们调查了早期切除阑尾是否会增加日后患精神障碍的风险。
所有在 1973 年至 1992 年间出生的瑞典个体（N=1937488）均被纳入并前瞻性随访至 2016 年 12 月 31 日，以记录 14 岁以后的任何精神疾病国际疾病分类诊断。主要暴露因素定义为 14 岁前有阑尾切除术史（N=44259）；第二个暴露因素为 14 岁前患有阑尾炎但未行阑尾切除术（N=1542），第三个暴露因素为 14 岁前的疝气手术史（N=35523）。每个暴露因素的对照组均为研究人群中未暴露的个体。
14 岁前接受阑尾切除术的个体患抑郁症的风险增加 19%（调整后的危险比[aHR] =1.19；95%置信区间[95%CI]：1.15-1.23），患双相情感障碍的风险增加 27%（aHR=1.27；95%CI：1.17-1.37），患焦虑障碍的风险增加 20%（aHR=1.20；95%CI：1.16-1.23），与未接受儿童阑尾切除术的个体相比。我们发现阑尾切除术与强迫症和精神分裂症风险增加无关，而无阑尾切除术的阑尾炎与精神障碍无关。儿童疝气手术与日后精神障碍之间的关联虽小，但具有统计学意义。
儿童阑尾切除术，但不是无阑尾切除术的阑尾炎，与成年后患情绪和焦虑障碍的风险显著增加有关。
