Halablab Saleem M, Alrazim Ayman, Sadaka Christian, Slika Hasan, Adra Nour, Ghusn Wissam, Shmais Manar, Sharara Ala I
Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Inflamm Intest Dis. 2023 Apr 15;8(1):34-40. doi: 10.1159/000530689. eCollection 2023 Jan-Dec.
The development and course of inflammatory bowel disease appear to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn's disease (CD) and a protective role in ulcerative colitis. This study aims to examine the effect of smoking on need for surgery in patients with moderate to severe CD receiving biologic therapy.
This was a retrospective study of adult patients with CD at a University Medical Center over a 20-year period.
A total of 251 patients were included (mean age 36.0 ± 15.0; 70.1% males; current, former, and nonsmokers: 44.2%, 11.6%, and 43.8%, respectively). Mean duration on biologics was 5.0 ± 3.1 years (>2/3 received anti-TNFs, followed by ustekinumab in 25.9%) and a third of patients (29.5%) received more than one biologic. Disease-related surgeries (abdominal, perianal, or both) occurred in 97 patients (38.6%): 50 patients had surgeries prior to starting biologics only, 41 had some surgeries after, and 6 had insufficient information. There was no significant difference in surgeries between ever-smokers (current or previous) versus nonsmokers in the overall study group. On logistic regression, the odds of having any CD surgery were higher in patients with longer disease duration (OR = 1.05, 95% CI = 1.01, 1.09) and in those receiving more than one biologic (OR = 2.31, 95% CI = 1.16, 4.59). However, among patients who had surgery prior to biologic therapy, smokers were more likely to have perianal surgery compared to nonsmokers (OR = 10.6, 95% CI = 2.0, 57.4; = 0.006).
In biologic-naive CD patients requiring surgery, smoking is an independent predictor of perianal surgery. Smoking, however, is not an independent risk factor for surgery in this cohort after starting biologics. The risk of surgery in those patients is primarily associated with disease duration and the use of more than one biologic.
炎症性肠病的发生和病程似乎受环境因素影响。尤其是，吸烟已被证明在克罗恩病（CD）中起有害作用，而在溃疡性结肠炎中起保护作用。本研究旨在探讨吸烟对接受生物治疗的中度至重度CD患者手术需求的影响。
这是一项对某大学医学中心20年间成年CD患者的回顾性研究。
共纳入251例患者（平均年龄36.0±15.0岁；男性占70.1%；当前吸烟者、既往吸烟者和从不吸烟者分别占44.2%、11.6%和43.8%）。生物制剂的平均使用时间为5.0±3.1年（超过2/3接受抗TNF治疗，25.9%接受乌司奴单抗治疗），三分之一的患者（29.5%）接受过不止一种生物制剂治疗。97例患者（38.6%）进行了与疾病相关的手术（腹部、肛周或两者皆有）：50例患者仅在开始使用生物制剂之前进行了手术，41例在之后进行了一些手术，6例信息不足。在整个研究组中，曾经吸烟者（当前或既往）与从不吸烟者之间的手术情况无显著差异。逻辑回归分析显示，病程较长的患者进行任何CD手术的几率较高（OR = 1.05，95%CI = 1.01，1.09），接受不止一种生物制剂治疗的患者也是如此（OR = 2.31，95%CI = 1.16，4.59）。然而，在生物治疗之前进行手术的患者中，吸烟者比不吸烟者更有可能进行肛周手术（OR = 10.6，95%CI = 2.0，57.4；P = 0.006）。
在需要手术的初治CD患者中，吸烟是肛周手术的独立预测因素。然而，在开始使用生物制剂后，吸烟并非该队列患者手术的独立危险因素。这些患者的手术风险主要与病程和使用不止一种生物制剂有关。
