 目的： 评估肠胃失调与患类风湿关节炎风险之间的关系。 方法： 法国E3N队列研究——欧洲癌症和营养前瞻性调查研究是一项法国前瞻性队列研究，自1990年以来，有98 995位健康妇女参与了调查研究。参与者完成了有关他们生活方式和健康相关信息的邮寄问卷调查。第三份问卷调查（于1993年寄出）针对胃肠失调进行了评估。研究采用Cox比例风险回归模型，并将年龄设为时间尺度，对发生类风湿关节炎的危险比和95％置信区间进行了估算。 对模型中的年龄进行调整，接着再对已知的类风湿关节炎危险诱因（例如吸烟）和潜在的共同诱因进行调整。 结果： 在65 424名妇女中，有530例被证实的类风湿关节炎病例是在平均基线（S.D.）11.7（5.9）年后确诊的。在随访期间，同无胃肠道疾病相比，慢性腹泻与患类风湿关节炎风险的增加相关（危险比= 1.70，95％CI ：1.13，2.58），与甲状腺功能减退症或饮食习惯无关。 这样的关联在吸烟者中表现得更强（危险比= 2.21，95％CI：1.32，3.70）。 患类风湿关节炎的风险与便秘或交替性腹泻/便秘之间没有关联。 结论： 慢性腹泻与患类风湿关节炎的风险增加有关，尤其在吸烟者中这种关联更为突出。这些数据与类风湿关节炎的黏膜起源假设相符，在该假设中，肠道营养不良与吸烟之间的相互作用可能会在早期触发自身免疫，随后几年才出现临床疾病。 原文 Chronic diarrhoea and risk of rheumatoid arthritis: findings from the French E3N-EPIC Cohort Study Objective To assess the relationship between gastrointestinal disorders and the risk of further development of RA. Methods The Etude Epidémiologique auprès des femmes de la Mutuelle générale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition Study is a French prospective cohort including 98 995 healthy women since 1990. Participants completed mailed questionnaires on their lifestyles and health-related information. Gastrointestinal disorders were assessed in the third questionnaire (sent in 1993). Hazard ratios and 95% CIs for incident RA were estimated using Cox proportional hazards regression models with age as the time scale. Models were age adjusted, and then additionally adjusted for known risk factors of RA such as smoking, and for potential cofounders. Results Among 65 424 women, 530 validated incident RA cases were diagnosed after a mean (S.D.) of 11.7 (5.9) years after study baseline. In comparison with no gastrointestinal disorder, chronic diarrhoea was associated with an increased risk of developing RA during follow-up (hazard ratio = 1.70, 95% CI 1.13, 2.58), independently of dysthyroidism or dietary habits. The association was stronger among ever-smokers (hazard ratio = 2.21, 95% CI 1.32, 3.70). There was no association between RA risk and constipation or alternating diarrhoea/constipation. Conclusion Chronic diarrhoea was associated with an increased risk of subsequent RA development, particularly among ever-smokers. These data fit with the mucosal origin hypothesis of RA, where interaction between intestinal dysbiosis and smoking could occur at an early stage to promote emergence of autoimmunity, followed years later by clinical disease. 文章出处 https:///10.1093/rheumatology/keaa133 作者：Yann Nguyen, Xavier Mariette, Carine Salliot, Gaëlle Gusto, Marie-Christine Boutron-Ruault, Raphaèle Seror |
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