瑞典学者的一项流行病学研究表明，吸烟与自身免疫性糖尿病风险降低相关，可能与其对自身免疫过程的抑制作用有关。但在超重男性中吸烟则可升高2型糖尿病风险。论文于2012年11月19日在线发表于《糖尿病护理》（Diabetes Care）杂志。
此项研究以来自于3项调查的90819例人群为受试者（男性48%，年龄≥20岁）。通过调查问卷确认糖尿病病例，并基于谷氨酸脱羧酶抗体（GADA）将其分类为2型糖尿病（1860例）和自身免疫性糖尿病（140例）。利用Cox比例风险回归模型计算混淆因素校正后危险比（HR）。
结果显示，在当前和重度吸烟者中自身免疫性糖尿病风险分别降低48%（HR 0.52）和58%（HR 0.42）。风险降低与吸烟年包数呈正相关。重度吸烟与GADA低水平和C肽高水平具有相关性。与之相反，在超重男性中吸烟与2型糖尿病风险升高相关。归咎于超重和重度吸烟交互作用的归因比例估计值为0.40。
OBJECTIVE
To investigate the association between smoking habits and risk of autoimmune diabetes in adults and of type 2 diabetes.
RESEARCH DESIGN AND METHODS
We used data from the three surveys of the Nord Trøndelag Health Study, spanning 1984–2008 and including a cohort of 90,819 Norwegian men (48%) and women (52%) aged ≥20 years. Incident cases of diabetes were identified by questionnaire and classified as type 2 diabetes (n = 1,860) and autoimmune diabetes (n = 140) based on antibodies to glutamic decarboxylase (GADA) and age at onset of diabetes. Hazard ratios (HR) adjusted for confounders were estimated by Cox proportion hazards regression models.
RESULTS
The risk of autoimmune diabetes was reduced by 48% (HR 0.52 [95% CI 0.30–0.89]) in current smokers and 58% in heavy smokers (0.42 [0.18–0.98]). The reduced risk was positively associated with number of pack-years. Heavy smoking was associated with lower levels of GADA (P = 0.001) and higher levels of C-peptide (964 vs. 886 pmol/L; P = 0.03). In contrast, smoking was associated with an increased risk of type 2 diabetes, restricted to overweight men (1.33 [1.10–1.61]). Attributable proportion due to an interaction between overweight and heavy smoking was estimated to 0.40 (95% CI 0.23–0.57).
CONCLUSIONS
In this epidemiological study, smoking is associated with a reduced risk of autoimmune diabetes, possibly linked to an inhibitory effect on the autoimmune process. An increased risk of type 2 diabetes was restricted to overweight men.
来源：Diabetes Care
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