过敏性疾病和自身免疫性疾病的长期风险:纵向队列研究和聚类分析
2020/02/11
摘要
背景：过敏性疾病（ADs）与自身免疫性疾病（AIDs）之间的关联尚不明确。
目的：为了确定过敏性鼻炎/结膜炎（ARC）、特应性湿疹（AE）和哮喘中艾滋病的发生率，并研究其共同发生的模式。
方法：设计：采用“健康改善网络”（英国初级保健数据库）进行的回顾性队列研究（1990年至2018年）。暴露组：各年龄段的过敏性鼻炎/结膜炎（ARC）、特应性湿疹（AE）和哮喘患者。对照组：对于每个暴露的患者，最多随机选择2名年龄和性别匹配的对照者，但不记录AD值。采用泊松回归计算校正后的发病率比 (aIRRs) 。还使用联合规则挖掘（ARM）进行了横断面研究，以研究疾病群。
结果：分别纳入782320、1 393570和1 049868例过敏性鼻炎/结膜炎（ARC）、特应性湿疹（AE）和哮喘患者。其中系统性红斑狼疮（SLE），干燥综合征（SS），白癜风，类风湿性关节炎（RA），牛皮癣，恶性贫血，炎症性肠病（IBD），腹腔疾病（CD）和自身免疫性甲状腺疾病的发病率在三种过敏性疾病中均高于对照组。具体来说，过敏性鼻炎/结膜炎中系统性红斑狼疮（1.45）和干燥综合征（1.88）的发病率较高；哮喘中的系统性红斑狼疮（1.44），干燥综合征（1.61）和肌无力（1.56）发病率较高; 特应性湿疹中的系统性红斑狼疮（1.86），干燥综合征（1.48），白癜风（1.54）和银屑病（2.41）发病率较高。这3种过敏性疾病对多发性硬化症无明显作用，ARC和AE对肌无力没有明显作用。分组：过敏性疾病合并多重艾滋病。确定了三个与年龄和性别相关的群体，在≥55岁的女性中模式相对复杂。
结论：在过敏性疾病患者中，艾滋病的长期风险显著升高。过敏性疾病和艾滋病表现出与年龄和性别相关的聚集模式。
Allergic Diseases and Long Term Risk of Autoimmune Disorders: longitudinal cohort study and cluster analysis.
Krishna MT.et al. Eur Respir J. 2019 Aug 14.
Abstract
BACKGROUND:The association between allergic diseases (ADs) and autoimmune disorders (AIDs) is not well established.
OBJECTIVE:To determine incidence rates of AIDs in allergic rhinitis/conjunctivitis (ARC), atopic eczema (AE) and asthma, and investigate for co-occurring patterns.
METHODS:Design: Retrospective cohort study (1990-2018) employing "The Health Improvement Network" (UK primary care database).Exposure group: ARC, AE and asthma - all ages.Controls: For each exposed patient, up to 2 randomly selected age- and gender-matched controls with no documented AD.Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression. A cross-sectional study was also conducted employing Association Rule Mining (ARM) to investigate disease clusters.
RESULTS:782 320, 1 393 570 and 1 049 868 patients with ARC, AE and asthma, respectively, were included. aIRRs of systemic lupus erythematosus (SLE), Sjogren's syndrome (SS), vitiligo, rheumatoid arthritis (RA), psoriasis, pernicious anaemia, inflammatory bowel disease (IBD), coeliac disease (CD) and autoimmune thyroid disease were uniformly higher in the 3 ADs compared to controls. Specifically, aIRRs of SLE (1.45) and SS (1.88) were higher in ARC; SLE (1.44), SS (1.61) and myasthenia (1.56) higher in asthma; SLE (1.86), SS (1.48), vitiligo (1.54) and psoriasis (2.41) higher in AE.There was no significant effect of the 3 ADs on multiple sclerosis and ARC and AE on myasthenia.ARM: ADs clustered with multiple AIDs. Three age- and gender-related clusters were identified, with relatively complex pattern in females ≥55 years.
CONCLUSION:The long-term risk of AIDs are significantly higher in patients with ADs. ADs and AIDs show age- and gender-related clustering patterns.
背景：过敏性疾病（ADs）与自身免疫性疾病（AIDs）之间的关联尚不明确。
目的：为了确定过敏性鼻炎/结膜炎（ARC）、特应性湿疹（AE）和哮喘中艾滋病的发生率，并研究其共同发生的模式。
方法：设计：采用“健康改善网络”（英国初级保健数据库）进行的回顾性队列研究（1990年至2018年）。暴露组：各年龄段的过敏性鼻炎/结膜炎（ARC）、特应性湿疹（AE）和哮喘患者。对照组：对于每个暴露的患者，最多随机选择2名年龄和性别匹配的对照者，但不记录AD值。采用泊松回归计算校正后的发病率比 (aIRRs) 。还使用联合规则挖掘（ARM）进行了横断面研究，以研究疾病群。
结果：分别纳入782320、1 393570和1 049868例过敏性鼻炎/结膜炎（ARC）、特应性湿疹（AE）和哮喘患者。其中系统性红斑狼疮（SLE），干燥综合征（SS），白癜风，类风湿性关节炎（RA），牛皮癣，恶性贫血，炎症性肠病（IBD），腹腔疾病（CD）和自身免疫性甲状腺疾病的发病率在三种过敏性疾病中均高于对照组。具体来说，过敏性鼻炎/结膜炎中系统性红斑狼疮（1.45）和干燥综合征（1.88）的发病率较高；哮喘中的系统性红斑狼疮（1.44），干燥综合征（1.61）和肌无力（1.56）发病率较高; 特应性湿疹中的系统性红斑狼疮（1.86），干燥综合征（1.48），白癜风（1.54）和银屑病（2.41）发病率较高。这3种过敏性疾病对多发性硬化症无明显作用，ARC和AE对肌无力没有明显作用。分组：过敏性疾病合并多重艾滋病。确定了三个与年龄和性别相关的群体，在≥55岁的女性中模式相对复杂。
结论：在过敏性疾病患者中，艾滋病的长期风险显著升高。过敏性疾病和艾滋病表现出与年龄和性别相关的聚集模式。
（中国医科大学附属第一医院 李文扬 摘译 杨冬 审校）
（Krishna MT.et al. Eur Respir J. 2019 Aug 14.）
（Krishna MT.et al. Eur Respir J. 2019 Aug 14.）
Allergic Diseases and Long Term Risk of Autoimmune Disorders: longitudinal cohort study and cluster analysis.
Krishna MT.et al. Eur Respir J. 2019 Aug 14.
Abstract
BACKGROUND:The association between allergic diseases (ADs) and autoimmune disorders (AIDs) is not well established.
OBJECTIVE:To determine incidence rates of AIDs in allergic rhinitis/conjunctivitis (ARC), atopic eczema (AE) and asthma, and investigate for co-occurring patterns.
METHODS:Design: Retrospective cohort study (1990-2018) employing "The Health Improvement Network" (UK primary care database).Exposure group: ARC, AE and asthma - all ages.Controls: For each exposed patient, up to 2 randomly selected age- and gender-matched controls with no documented AD.Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression. A cross-sectional study was also conducted employing Association Rule Mining (ARM) to investigate disease clusters.
RESULTS:782 320, 1 393 570 and 1 049 868 patients with ARC, AE and asthma, respectively, were included. aIRRs of systemic lupus erythematosus (SLE), Sjogren's syndrome (SS), vitiligo, rheumatoid arthritis (RA), psoriasis, pernicious anaemia, inflammatory bowel disease (IBD), coeliac disease (CD) and autoimmune thyroid disease were uniformly higher in the 3 ADs compared to controls. Specifically, aIRRs of SLE (1.45) and SS (1.88) were higher in ARC; SLE (1.44), SS (1.61) and myasthenia (1.56) higher in asthma; SLE (1.86), SS (1.48), vitiligo (1.54) and psoriasis (2.41) higher in AE.There was no significant effect of the 3 ADs on multiple sclerosis and ARC and AE on myasthenia.ARM: ADs clustered with multiple AIDs. Three age- and gender-related clusters were identified, with relatively complex pattern in females ≥55 years.
CONCLUSION:The long-term risk of AIDs are significantly higher in patients with ADs. ADs and AIDs show age- and gender-related clustering patterns.
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