Clinic of Rheumatology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
Turk J Med Sci. 2023 Feb;53(1):121-129. doi: 10.55730/1300-0144.5565. Epub 2023 Feb 22.
The etiology of Behçet's disease (BD) is not clearly known, however, abnormal activity in T helper (Th) 1, Th 17, and regulatory T cells (Treg) has critical importance in pathogenesis. It has been shown that the intestinal microbiome can be effective in the modulation of these immune abnormalities in BD patients. Breastfeeding increases the maturation of the infant's intestinal permeability by affecting the newborn's immature intestinal microbiome and metagenome. We aimed to examine the effects of breastfeeding on disease related symptoms, organ involvements and course of the disease in BD patients.
This study was designed as a cross-sectional study in Ankara City Hospital rheumatology clinic between December 2021 and March 2022. Patients who were diagnosed with BD by meeting the criteria of the 'International Study Group' and whose information we could access by agreeing to participate in the study were enrolled. The mothers of the patients were also contacted and asked whether these patients were breastfed, the duration of breastfeeding, and the mode of birth. Demographic and clinical data of the patients, comorbid diseases, and drugs used for BD were collected from the records in the hospital database. The presence of sacroiliitis in patients was evaluated with sacroiliac X-ray and/or magnetic resonance imaging (MRI), which was requested because of low back pain symptoms and only patients with previous sacroiliac imaging for low back pain were included in the study. BD-related organ damage was measured by the Vasculitis Damage Index (VDI) and Behçet's syndrome Overall Damage Index (BODI) scores.
: A total of 304 patients were included in the study. The percentage of patients who were reported to have ever breastfed (median duration (IQR): 12(12) months, 33.5% < 6 months, 66.4% ≥ 6 months, and 59.6% ≥ 12 months) is 92%. When the breastfed and nonbreastfed patients were compared, 6.8% of the breastfed patients needed TNF-i against 18.2% of the nonbreastfed patients (p = 0.052). While the rate of having at least one comorbidity was 26.4% for those who were breastfed, this rate was 50% for those who had never been breastfed. When the organ and system involvements of the patients were compared, the incidence of sacroiliitis was statistically significantly higher in the nonbreastfed group (p = 0.025). Patients who were breastfed for less than 6 months were diagnosed with BD at an earlier age than those who were breastfed for more than 6 months, and those who were breastfed for less than 12 months compared to those who were breastfed for more than 12 months (respectively, p = 0.039, p = 0.035).
Our results imply that history of breastfeeding may have some positive effects on the course of the disease in BD patients.
白塞病（BD）的病因尚不清楚，然而，辅助性 T 细胞（Th）1、Th17 和调节性 T 细胞（Treg）的异常活动在发病机制中具有重要意义。已经表明，肠道微生物组可以通过影响 BD 患者不成熟的肠道微生物组和宏基因组来有效调节这些免疫异常。母乳喂养通过影响新生儿不成熟的肠道微生物组和宏基因组，增加婴儿肠道通透性的成熟度。我们旨在研究母乳喂养对 BD 患者疾病相关症状、器官受累和疾病病程的影响。
本研究为 2021 年 12 月至 2022 年 3 月在安卡拉城市医院风湿病诊所进行的横断面研究。通过满足“国际研究小组”标准诊断为 BD 的患者及其信息，通过同意参与研究可以获得这些患者被招募。还联系了患者的母亲，询问这些患者是否母乳喂养、母乳喂养的持续时间以及分娩方式。从医院数据库中的记录中收集患者的人口统计学和临床数据、合并症和用于 BD 的药物。通过骶髂 X 射线和/或磁共振成像（MRI）评估患者的骶髂关节炎，仅对因下腰痛症状而请求进行骶髂成像的患者进行研究。通过血管炎损伤指数（VDI）和白塞病综合损伤指数（BODI）评分测量 BD 相关器官损伤。
共纳入 304 例患者。报告有过母乳喂养史的患者比例（中位数持续时间（IQR）：12（12）个月，33.5% < 6 个月，66.4% ≥ 6 个月，59.6% ≥ 12 个月）为 92%。与非母乳喂养患者相比，母乳喂养患者中需要使用 TNF-i 的比例为 6.8%，而非母乳喂养患者为 18.2%（p=0.052）。母乳喂养患者至少有一种合并症的发生率为 26.4%，而从未母乳喂养的患者为 50%。当比较患者的器官和系统受累情况时，非母乳喂养组的骶髂关节炎发生率明显更高（p=0.025）。母乳喂养不足 6 个月的患者比母乳喂养超过 6 个月的患者更早被诊断为 BD，而母乳喂养不足 12 个月的患者比母乳喂养超过 12 个月的患者更早被诊断为 BD（分别为，p=0.039，p=0.035）。
我们的结果表明，母乳喂养史可能对白塞病患者的病程有一些积极影响。
