Smoking, Use of Moist Snuff, and Risk of Chronic Inflammatory Diseases
Smoking, Use of Moist Snuff, and Risk of Chronic Inflammatory Diseases
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DOI：
10.1164/rccm.200909-1338oc
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发表时间：
2010-06-01
影响因子：
24.7
通讯作者：
Askling, Johan
中科院分区：
文献类型：
--
作者：
Carlens, Cecilia;Hergens, Maria-Pia;Askling, Johan
原理：吸烟正在成为慢性炎症性疾病病因学中的一个强有力的危险因素。同样的情况是否也适用于无烟烟草仍然不得而知。尼古丁是一种强有力的炎症反应调节剂。通过比较与吸烟和无烟烟草相关的风险，尼古丁在慢性炎症发展中的作用可以评估Objectives：评估和比较与吸烟和使用瑞典湿鼻烟相关的类风湿性关节炎（RA）、溃疡性结肠炎（UC）、克罗恩病（CD）、结节病和多发性硬化症（MS）的风险。我们对瑞典建筑工人队列中的277，777名男性进行了队列研究，他们提供了1978-1993年的烟草使用信息。交叉链接到全国范围的瑞典医院出院登记提供了2004年RA、UC、CD、结节病和MS发生的信息。测量和主要结果：分别用考克斯回归估计与吸烟和湿鼻烟相关的经X线校正的相对危险度（RR）。长期吸烟与类风湿关节炎风险增加有关（RR，2.1; 95%置信区间[Cl]，1.7-2.5），CD（RR，1.5; 95% CI，1.2-1.8），MS（RR，1.9; 95% CI，1.4-2.6）和UC（RR，1.3; 95% CI，1.1-1.5，仅限于既往吸烟者），以及结节病风险降低（RR，0.5; 95% CI，0.4-0.5）。相比之下，经常使用湿鼻烟，调整吸烟，与类风湿关节炎无关（RR，1.0; 95% CI，0.9-1.2），UC（RR，1.1; 95% CI，0.9-1.2），CD（RR，0.9; 95% CI，0.8-1.1），结节病（RR，1.1; 95% Cl，0.8-1.5）或MS（RR，1.0; 95% CI，0.8-1.4）。无烟烟草不会增加慢性炎症性疾病的风险，这表明在这些疾病的病因学中，吸入的香烟烟雾的非烟碱成分比尼古丁本身更重要。
Rationale: Cigarette smoking is emerging as a strong risk factor in the otherwise unknown etiology of chronic inflammatory diseases. Whether the same applies also to smokeless tobacco remains unknown. Nicotine is a powerful modifier of the inflammatory response. By comparing risks associated with tobacco smoking and with smokeless tobacco, the role of nicotine in the development of chronic inflammation may be evaluated.Objectives: To assess and compare the risks of rheumatoid arthritis (RA), ulcerative colitis (UC), Crohn's disease (CD), sarcoidosis, and multiple sclerosis (MS) associated with cigarette smoking and with the use of Swedish moist snuff.Methods: We performed a cohort study of 277,777 males within a cohort of Swedish construction workers who had provided information about tobacco use in 1978-1993. Cross-linkage to the nationwide Swedish Hospital Discharge Register provided information about the occurrence of RA, UC, CD, sarcoidosis, and MS through 2004.Measurements and Main Results: Age-adjusted relative risks (RRs) associated with smoking and moist snuff, respectively, were estimated by Cox regression. Ever-smoking was associated with an increased risk for RA (RR, 2.1; 95% confidence interval [Cl], 1.7-2.5), CD (RR, 1.5; 95% CI, 1.2-1.8), MS (RR, 1.9; 95% CI, 1.4-2.6), and UC (RR, 1.3; 95% CI, 1.1-1.5, confined to ex-smokers), and a decreased risk of sarcoidosis (RR, 0.5; 95% Cl, 0.4-0.5). By contrast, ever-use of moist snuff, adjusted for smoking, was not associated with RA (RR, 1.0; 95% Cl, 0.9-1.2), UC (RR, 1.1; 95% Cl, 0.9-1.2), CD (RR, 0.9; 95% CI, 0.8-1.1), sarcoidosis (RR, 1.1; 95% Cl, 0.8-1.5), or MS (RR, 1.0; 95% CI, 0.8-1.4).Conclusions: Smokeless tobacco does not increase the risk of chronic inflammatory diseases, suggesting that inhaled nonnicotinic components of cigarette smoke are more important than nicotine itself in the etiology of these diseases.