Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Division of Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.
PLoS One. 2020 Oct 2;15(10):e0239723. doi: 10.1371/journal.pone.0239723. eCollection 2020.
Allergic rhinitis (AR) is a burdensome respiratory disorder whose etiology and pathophysiology remain controversial and most likely multifactorial. Accumulated evidence indicates that gut dysbiosis contributes to AR via the gut-airway axis. Constipation could result in alteration of the intestinal microflora. The clinical impact of constipation on AR has not been studied. We aimed to evaluate the risk of AR in constipated patients using a nationwide longitudinal population-based cohort.
We identified 57786 patients with constipation and 57786 matched controls between 1999 and 2013 from the Longitudinal Health Insurance Database, which is a subset of Taiwanese National Health Insurance Research Database. Propensity score analysis was used for matching age, sex, comorbidities, and medications at a ratio of 1:1. Multiple Cox regression and subgroup analyses were used to estimate the adjusted hazard ratio of AR.
The incidence of AR was 32.2 per 1,000 person-years in constipated patients, which was twice that of non-constipated patients. After adjustment for patients' age, gender, comorbidities, and medications, patients with constipation had a 2.3-fold risk of AR compared to those without constipation (adjusted hazard ratio [aHR]: 2.30; 95% CI, 2.23-2.37). In subgroup analyses, patients aged 20-39 years had a 2.24-fold higher risk of AR in the constipation cohort (aHR; 95% CI, 2.12-2.36). Patients aged <20, 40-64, and ≥65 years had a 2.09, 2.05, and 2.07-fold risk of AR in the constipation cohort, respectively (aHR; 95% CI, 1.98-2.20, 1.94-2.18, and 1.92-2.23). Also, patients with constipation had a higher likelihood of AR, regardless of sex, and with or without comorbidities including hyperlipidemia, hypertension, chronic kidney disease, chronic liver disease, diabetes, chronic obstructive pulmonary disease, rheumatoid arthritis, dyspepsia, irritable bowel syndrome, and anxiety.
Constipation might be associated with an increased risk of incidental AR. It seems that physicians should keep a higher index of suspicion for AR in people with constipation. The patency issue of gut could not be ignored in patients with AR.
变应性鼻炎（AR）是一种负担沉重的呼吸道疾病，其病因和病理生理学仍存在争议，很可能是多因素的。越来越多的证据表明，肠道菌群失调通过肠道-气道轴导致 AR。便秘可能导致肠道微生物群的改变。便秘对 AR 的临床影响尚未得到研究。我们旨在使用全国性纵向人群队列评估便秘患者发生 AR 的风险。
我们从 1999 年至 2013 年的纵向健康保险数据库中确定了 57786 例便秘患者和 57786 例匹配对照。使用倾向评分分析以 1:1 的比例匹配年龄、性别、合并症和药物。多 Cox 回归和亚组分析用于估计 AR 的调整后的危险比。
便秘患者的 AR 发生率为每 1000 人年 32.2 例，是无便秘患者的两倍。在调整患者年龄、性别、合并症和药物后，与无便秘患者相比，便秘患者发生 AR 的风险增加了 2.3 倍（调整后的危险比 [aHR]：2.30；95%CI，2.23-2.37）。在亚组分析中，年龄在 20-39 岁的便秘患者 AR 风险增加了 2.24 倍（aHR；95%CI，2.12-2.36）。年龄<20、40-64 和≥65 岁的便秘患者 AR 风险分别增加了 2.09、2.05 和 2.07 倍（aHR；95%CI，1.98-2.20、1.94-2.18 和 1.92-2.23）。此外，无论性别、是否合并高脂血症、高血压、慢性肾脏病、慢性肝病、糖尿病、慢性阻塞性肺疾病、类风湿关节炎、消化不良、肠易激综合征和焦虑症，便秘患者发生 AR 的可能性都更高。
便秘可能与 AR 的发生风险增加有关。看来，医生在治疗便秘患者时应更加警惕 AR 的发生。在 AR 患者中，肠道通畅问题不容忽视。
