Svanes C, Søreide J A, Skarstein A, Fevang B T, Bakke P, Vollset S E, Svanes K, Søoreide O
Department of Surgery, Haukeland University Hospital, Bergen, Norway.
Gut. 1997 Aug;41(2):177-80. doi: 10.1136/gut.41.2.177.
The use of ulcerogenic drugs is the only well documented risk factor for peptic ulcer perforation, but accounts for only a quarter of the events. Smoking is a well known risk factor for uncomplicated ulcer disease, and patients with ulcer bleeding have increased death rates from smoking related disorders.
To assess the role of smoking in ulcer perforation.
A total of 168 consecutive patients with gastroduodenal ulcer perforation and 4469 control subjects from a population based health survey.
The association between ulcer perforation and smoking habits was analysed by logistic regression while adjusting for age and sex.
Current smoking increased the risk for ulcer perforation 10-fold in the age group 15-74 years (OR 9.7, 95% CI 5.9 to 15.8) and there was a highly significant dose-response relationship (p < 0.001). The results were similar in men (OR 9.3, 95% CI 4.9 to 17) and women (OR 11.6, 95% CI 5.3 to 25), and for gastric (OR 10.5, 95% CI 4.5 to 25) and duodenal (OR 8.6, 95% CI 4.9 to 15.4) ulcer perforation. No increase in risk was found in previous smokers (OR 0.8, 95% CI 0.2 to 2.2).
Our findings suggest that smoking is a causal factor for ulcer perforation and accounts for a major part of ulcer perforations in the population aged less than 75 years.
使用致溃疡药物是消化性溃疡穿孔唯一有充分文献记载的危险因素，但仅占此类事件的四分之一。吸烟是众所周知的单纯性溃疡病危险因素，溃疡出血患者因吸烟相关疾病导致的死亡率升高。
评估吸烟在溃疡穿孔中的作用。
连续纳入168例胃十二指肠溃疡穿孔患者以及4469名来自基于人群的健康调查的对照者。
采用logistic回归分析溃疡穿孔与吸烟习惯之间的关联，并对年龄和性别进行校正。
在15 - 74岁年龄组中，当前吸烟者发生溃疡穿孔的风险增加了10倍（比值比9.7，95%可信区间5.9至15.8），且存在高度显著的剂量反应关系（p < 0.001）。男性（比值比9.3，95%可信区间4.9至17）和女性（比值比11.6，95%可信区间5.3至25），以及胃溃疡穿孔（比值比10.5，95%可信区间4.5至25）和十二指肠溃疡穿孔（比值比8.6，95%可信区间4.9至15.4）的结果相似。既往吸烟者未发现风险增加（比值比0.8，95%可信区间0.2至2.2）。
我们的研究结果表明，吸烟是溃疡穿孔的一个病因，且在75岁以下人群的溃疡穿孔中占主要部分。
