摘要 目的：评价饮酒量与类风湿关节炎发生风险的量效关系。

方法：检索MEDLINE，Embase和Web of Science数据库1946年1月1日至2013年4月10日发表的文献，回顾会议摘要以及参考文献。纳入评价饮酒与RA发生风险并报告了相对危险度（RRs）以及95%可信区间的前瞻性研究。将各研究结果进行剂量-效应荟萃分析。

结果：至2013年4月10日，共纳入8个前瞻性研究，包含195029参加者和1878例RA患者。结果显示低中等量饮酒对RA的发病具有保护作用（RR: 0.86; 95% CI 0.78 - 0.94），饮酒量与RA风险之间具有非线性相关性。剂量-效应荟萃分析显示与非饮酒者相比，饮酒量3g/天的校正RR值为0.93 (95% CI 0.88 -0.98)，饮酒量9g/天的校正RR值为0.86 (95% CI 0.76 -0.97)，饮酒量12g/天的校正RR值为0.88 (95% CI 0.78 -0.99)，饮酒量15g/天的校正RR值为0.91 (95% CI 0.81 -1.03)，饮酒量30g/天的校正RR值为1.28 (95% CI 0.94 -1.73)。亚组分析提示低中等量饮酒的女性RA患病风险降低19%。不考虑性别因素，持续低中等量饮酒10年以上可以使RA发病风险降低17%。

结论：低中等量饮酒与RA的发病负相关，具有剂量依赖性，时间依赖性和性别依赖性。尚需要进行大规模前瞻性研究探讨基因与环境之前的相互作用，进而阐明RA的病因。

附原文：Abstract OBJECTIVE: To summarise the evidence regarding the dose-response association between alcohol consumption and risk of rheumatoid arthritis (RA). METHOD: Studies were identified from search of MEDLINE, Embase and Web of Science databases between 1 January 1946 and 10 April 2013, and from review of the conference abstracts and the reference lists of retrieved articles. Prospective studies that reported relative risks (RRs) with 95% CIs for the association between alcohol consumption and the risk of RA were included. Results from individual studies were pooled using a dose-response meta-analysis. RESULTS: Up to 10 April 2013, 8 prospective studies contained 195 029 participants and 1878 RA cases were included. The results indicated that low to moderate alcohol consumption yielded a preventive effect on RA development (RR: 0.86; 95% CI 0.78 to 0.94), and provided some evidence of a non-linear relationship between alcohol consumption and risk of RA. Dose-response meta-analysis of the study data revealed that compared with that for no alcohol consumption, the adjusted RR was 0.93 (95% CI 0.88 to 0.98) for 3 g/day of alcohol consumption, 0.86 (95% CI 0.76 to 0.97) for 9 g/day, 0.88 (95% CI 0.78 to 0.99) for 12 g/day, 0.91 (95% CI 0.81 to 1.03) for 15 g/day, and 1.28 (95% CI 0.94 to 1.73) for 30 g/day. Subgroup analysis indicated that women who had low to moderate alcohol consumption had a 19% reduction in RA risk. Regardless of sex, a consistent low to moderate alcohol consumption for a period of at least 10 years was found to have a 17% reduction in RA risk. CONCLUSIONS: Low to moderate alcohol consumption inversely associated with the development of RA in a manner that appears to be dose-dependent, time-dependent and sex-dependent. Large prospective studies that investigate gene-environment interactions are required to further clarify the aetiology of RA.

引自：Jin Z, Xiang C, Cai Q, Wei X, He J. Alcohol consumption as a preventive factor for developing rheumatoid arthritis: a dose-response meta-analysis of prospective studies. Ann Rheum Dis. 2013 Jul 29. doi: 10.1136/annrheumdis-2013-203323. [Epub ahead of print]