鼻炎、鼻窦炎与痴呆风险：系统综述与荟萃分析

文献信息

中文摘要

引言： 本研究旨在系统综述关于鼻炎或鼻窦炎与痴呆风险之间关联的流行病学证据。
方法： 本综述遵循PRISMA 2020指南以及已在PROSPERO注册的方案（CRD420251181185）。对Medline、EMBASE、CINAHL和Web of Science数据库进行了全面检索，纳入截至2025年10月发表的文献。检索策略纳入了“rhinitis”或“sinusitis”以及“dementia”或“Alzheimer”等术语。我们纳入了报告被诊断为鼻炎或鼻窦炎的成人中痴呆风险的队列研究、病例对照研究和孟德尔随机化研究。我们定义了三个PECO问题，以指导数据合成，并使用GRADE方法评估证据确定性。在荟萃分析中，采用随机效应模型合并风险比（HR）或比值比（OR）。针对每种研究设计评估了偏倚风险。
结果： 共有8篇文章符合纳入标准，且均适合进行荟萃分析。在纳入的文章中，有1篇文章同时包含队列研究和病例对照设计，因此最终分析共有9个研究单元。三项队列研究显示鼻炎或鼻窦炎与全因痴呆之间存在关联（HR 1.10，95% CI：1.09-1.11）。然而，在队列或病例对照分析中，鼻炎或鼻窦炎与阿尔茨海默病均无显著关联。在队列或孟德尔随机化分析中，均无证据表明过敏性鼻炎与阿尔茨海默病之间存在关系。证据确定性从低到极低不等。大多数研究被判定为低偏倚风险。
结论： 在队列分析中，鼻炎或鼻窦炎与全因痴呆风险轻度升高相关，但研究间的不一致性和不精确性限制了因果推断。因此，需要纳入多样化人群并涵盖慢性鼻炎和鼻窦炎的大规模观察性研究或孟德尔随机化研究。还需要机制研究来阐明2型免疫反应是否可能促进神经退行性变。

英文摘要

INTRODUCTION: This study aimed to systematically review epidemiological evidence on the association between rhinitis or sinusitis and the risk of dementia.
METHODS: This review followed PRISMA 2020 guidelines and a protocol registered in PROSPERO (CRD420251181185). A comprehensive search was conducted in Medline, EMBASE, CINAHL, and Web of Science databases for literature published up to October 2025. The search strategy incorporated the terms of 'rhinitis' OR 'sinusitis' AND 'dementia' OR 'Alzheimer'. We included cohort, case-control, and Mendelian randomization studies that reported the risk of dementia among adults diagnosed with rhinitis or sinusitis. Three PECO questions were defined to guide data synthesis and the assessment of certainty of evidence using the GRADE approach. Hazard ratios (HRs) or odds ratios (ORs) were pooled using a random‑effects model in the meta‑analysis. Risk of bias was evaluated for each study design.
RESULTS: A total of eight articles met the inclusion criteria, all of which were suitable for meta‑analysis. Among the included articles, one article included both a cohort and a case‑control design, resulting in a total of nine study units in the final analysis. Three cohort studies showed an association between rhinitis or sinusitis and all-cause dementia (HR 1.10, 95% CI: 1.09-1.11). However, rhinitis or sinusitis was not significantly associated with Alzheimer's disease in either cohort or case-control analyses. There was no evidence of a relationship between allergic rhinitis and Alzheimer's disease in either cohort or Mendelian randomization analyses. Certainty of evidence ranged from low to very low. Most studies were judged to have a low risk of bias.
CONCLUSION: Rhinitis or sinusitis was associated with a modestly increased risk of all-cause dementia in the cohort analysis, but inconsistency and imprecision across studies limit causal inference. Therefore, large-scale observational or Mendelian randomization studies that include diverse populations and encompass both chronic rhinitis and sinusitis are needed. Mechanistic studies are also needed to elucidate whether type 2 immune responses may contribute to neurodegeneration.