Cigarette smoking and risk of total knee replacement for severe osteoarthritis among Chinese in Singapore--the Singapore Chinese health study.

Cigarette smoking and risk of total knee replacement for severe osteoarthritis among Chinese in Singapore--the Singapore Chinese health study.
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DOI:
10.1016/j.joca.2014.03.013
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发表时间:
2014-06
影响因子:
7
通讯作者:
Koh WP
Koh WP
中科院分区:
医学2区
文献类型:
--
作者:
Leung YY;Ang LW;Thumboo J;Wang R;Yuan JM;Koh WP

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关于吸烟对骨关节炎(OA)影响的数据不一致,也没有研究检查戒烟的影响。我们研究了新加坡中国老年人的吸烟状况、持续时间、剂量和戒烟与全膝关节置换术(TKR)治疗严重膝关节OA风险的关系。我们使用了来自新加坡华人健康研究的数据,这是一项基于人群的前瞻性队列研究,在1993年至1998年期间招募了63,257名年龄在45至74岁之间的中国男性和女性。通过面对面访谈获得了有关吸烟、当前饮食和生活方式因素的详细信息。截至2011年12月31日,通过与全国出院数据库的链接,确定了1,973例严重膝关节OA的TKR事件。我们使用考克斯回归方法来研究吸烟与TKR风险的关系,并对年龄、性别、教育、体重指数、合并症和体力活动水平进行了调整。与从不吸烟者相比,目前吸烟者的TKR风险降低了51%[风险比(HR)= 0.49; 95%置信区间(CI)= 0.40 - 0.60]。在当前吸烟者中,吸烟持续时间和剂量增加与TKR风险降低之间存在非常强的剂量依赖性相关性(趋势p <0.0001)。在既往吸烟者中,戒烟持续时间缩短与TKR风险降低之间存在剂量依赖性反应(趋势p = 0.034)。我们的研究结果强烈暗示吸烟是严重膝关节OA患者行全膝关节置换术的保护因素。这与尼古丁促进软骨细胞增殖和胶原蛋白合成的实验数据一致。
Data on the effects of cigarette smoking with osteoarthritis (OA) are inconsistent and no study has examined the effect of smoking cessation. We examined smoking status, duration, dosage and cessation in association with risk of total knee replacement (TKR) for severe knee OA among elderly Chinese in Singapore. We used data from the Singapore Chinese Health Study, a population-based prospective cohort of 63,257 Chinese men and women aged 45 to 74 years during enrolment between 1993 and 1998. Detailed information on smoking, current diet and lifestyle factors were obtained through in-person interviews. As of 31 December 2011, 1,973 incident TKR cases for severe knee OA had been identified via linkage with nationwide hospital discharge database. We used Cox regression methods to examine smoking in relation to TKR risk with adjustment for age, gender, education, body mass index, comorbidities and physical activity level. Compared to never smokers, current smokers had a 51% decrease in risk of TKR [Hazards ratio (HR) =0.49; 95% confidence interval (CI) =0.40-0.60]. Among current smokers, there was a very strong dose-dependent association between increasing duration and dosage of smoking with decreasing risk of TKR (p for trend<0.0001). Among former smokers, there was a dose-dependent response between decrease in duration of smoking cessation and reduction in TKR risk (p for trend=0.034). Our findings strongly implicate smoking as a protective factor for total knee replacement indicated for severe knee OA. This concurs with experimental data that nicotine promotes proliferation and collagen synthesis in chondrocytes.
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发表时间: 2013-07
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