当前吸烟可能与强直性脊柱炎发病相关

摘要 目的：吸烟能够引起强直性脊柱炎的进展。由于吸烟也是类风湿关节炎和银屑病关节炎的危险因素，我们研究的目的是探索吸烟习惯是否与强直性脊柱炎的发病相关。

方法：对来自于挪威北特伦德拉格郡整个成年人群的HUNT健康队列的数据进行分析。对HUNT2 (1995-1997)以及HUNT3 (2006-2008)的参与者进行分析，其中HUNT3报道诊断为强直性脊柱炎患者，但是HUNT2无报道(n = 107)。发生强直性脊柱炎事件与未患强直性脊柱炎患者（n = 35,278）纳入病例-对照研究。确诊类风湿关节炎患者被排除在外。

结果：调整潜在混杂因素后Logistic回归分析提示当前吸烟与自我报告的强直性脊柱炎显著相关（OR 1.99, 95% CI 1.28-3.11, p = 0.002）。既往吸烟(OR 1.15, 95% CI 0.66-2.02, p = 0.62)或者HUNT2队列的总包年数(OR 1.01, 95% CI 0.99-1.04, p = 0.21)与强直性脊柱炎发病无相关性。各种敏感性分析提示当前吸烟与强直性脊柱炎有显著相关，包括仅有高度可能确诊为强直性脊柱炎患者(OR 1.82, 95% CI 1.03-3.19, p = 0.04)、仅HUNT2数据收集3-5年后报告强直性脊柱炎患者(OR 2.34, 95% CI 1.09-5.03, p = 0.029)或者仅包括调整基因型后的HLA-B27基因型阳性(病例组94对照组859)参与者(OR 1.79, 95% CI 1.04-2.85, p = 0.033)。高血压也提示与强直性脊柱炎事件有相关性(OR from 1.65 to 2.81)。

结论：基于HUNT人群的研究发现强直性脊柱炎发生与当前吸烟以及高血压相关。如果进一步研究证实这一结论，应该劝阻包括有家族史或携带HLA-B27基因的高强直性脊柱炎风险的患者吸烟。

附原文：OBJECTIVE: Smoking contributes to progression of ankylosing spondylitis (AS). Because smoking is also a risk factor for incident rheumatoid arthritis (RA) and psoriatic arthritis, our aim was to test whether smoking habits are associated with incident AS.METHODS:Using data from the HUNT health study of the entire adult population of Nord-Tr?ndelag, Norway, participants in HUNT2 (1995-1997) and HUNT3 (2006-2008) were identified who reported a diagnosis of AS in HUNT3 but not in HUNT2 (n = 107). Incident AS cases were compared with AS-unaffected individuals (n = 35,278) in a case-control design. Participants with RA were excluded.RESULTS: Present smoking was significantly associated with incident self-reported AS in logistic regression adjusted for potential confounders (OR 1.99, 95% CI 1.28-3.11, p = 0.002). Previous smoking (OR 1.15, 95% CI 0.66-2.02, p = 0.62) or total pack-years at HUNT2 (OR 1.01, 95% CI 0.99-1.04, p = 0.21) were not significant. The association with present smoking remained significant in various sensitivity analyses: including only cases with high probability of true AS diagnosis (OR 1.82, 95% CI 1.03-3.19, p = 0.04); including only cases with AS reported more than 3-5 years after HUNT2 (OR 2.34, 95% CI 1.09-5.03, p = 0.029), or including only participants genotyped for HLA-B27 (94 cases and 859 controls) adjusting for genotype (OR 1.79, 95% CI 1.04-2.85, p = 0.033). Hypertension was also significantly associated with incident AS (OR from 1.65 to 2.81).CONCLUSION: In the HUNT population-based study, incident AS was associated with current smoking and hypertension. If verified in further studies, this suggests that smoking should be discouraged in those at a higher AS risk, e.g., with a family history or carrying HLA-B27.

引自：Videm V, Cortes A, Thomas R, Brown MA. Current Smoking is Associated with Incident Ankylosing Spondylitis - The HUNT Population-based Norwegian Health Study. J Rheumatol. 2014 Aug 15. pii: jrheum.140353. [Epub ahead of print]