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Many but not all studies have indicated that smoking is inversely associated with Parkinson's disease (PD). Meta-analysis of epidemiological studies on smoking and PD was performed to summarize data f...rom published studies. Fifty-four epidemiological studies (48 case-control and 6 cohort studies, 53 publications) were identified for potential inclusion in meta-analysis. The summary risk estimates for current smokers, former smokers, and ever (current and former) smokers were 0.31 (95% confidence interval (CI) = 0.25-0.38), 0.72 (95% CI = 0.63-0.83) and 0.55 (95% CI = 0. 51-0. 59), respectively. In stratified analysis by study design, smoking had a somewhat greater impact on PD risk in cohort studies than in case-control studies. However, meta-regression indicated that the study design did not significantly contribute to heterogeneity. Additional analyses were restricted to case-control studies because of the sufficient number of studies. Stratified analysis by ethnicity indicated that the summary OR for ever-smokers was nonsignificantly smaller in Asian populations than in Caucasian populations. In stratified analysis by source of controls, former smoking was significantly associated with a decreased risk of PD in hospital-based case-control studies but was marginally associated with a decreased risk in population-based case-control studies. The source of controls did not contribute significantly to heterogeneity. PD risk associated with ever-smoking was significantly lower for a hospital-based approach than a population-based approach. Among current smokers, the association held true to the same extent for both approaches. This meta-analysis indicated that smokers have a lower risk of PD. As PD is a multifactorial disease, further investigation of the smoking-gene interaction on PD risk may lead to a better understanding of the pathogenesis of PD.
喫煙はパーキンソン病リスクを低下させることが多くの研究で認められているが，すべての研究でその関連性が認められているわけではない．本研究の目的は，喫煙とパーキンソン病についての研究結果を統合するために，公表された研究についてのメタ分析を行うことである．54 の疫学研究（48 症例対照研究と６コホート研究，53 論文）がメタ分析の対象としての適格基準をみたしてい た．非喫煙に対する現在喫煙，過去喫煙および喫煙経験（現在喫煙＋過去喫煙）の統合リスクはそ れぞれ0.31（95%信頼区間（95% CI)= 0.25-0.38）, 0.72（95% CI = 0.63-0.83）および0.55（95%CI = 0.51-0.59）であった．次に，研究デザインによる層別解析（症例対照研究あるいはコホート研究）を行った．喫煙のパーキンソン病に対する予防効果はコホート研究において，症例対照研究よりもやや強く認められたが，統計学的な有意差は認められなかった．症例対照研究に限ってさらに層別解析を行った．人種（白人あるいはアジア人）による層別解析では，喫煙経験の統合リスクはややアジア人の方が白人よりも小さかった．対照の種類（住民対照あるいは病院対照）による層別解析では，病院対照を用いた場合は過去喫煙は有意にパーキンソン病のリスクを低下させていたが，住民対照を用いた場合はリスクを有意に低下させていなかった．しかし，両者の間に統計学的な有意差は認められなかった．喫煙経験によるリスク低下は病院対照を用いた症例対照研究の方が住民対照を用いた症例対照研究よりも有意に大きかった．現在喫煙のリスクは両者間で有意差はなかった．パーキンソン病は多因子疾患であるので，今後，喫煙−遺伝子交互作用についての研究を行うことによって，パーキンソン病の病因についてよりよい理解が得られると考えられる．show more
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