Association of Childhood Abuse with Incident Systemic Lupus Erythematosus in Adulthood in a Longitudinal Cohort of Women
Association of Childhood Abuse with Incident Systemic Lupus Erythematosus in Adulthood in a Longitudinal Cohort of Women
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DOI：
10.3899/jrheum.190009
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发表时间：
2019-12-01
影响因子：
3.9
通讯作者：
Roberts, Andrea L.
中科院分区：
文献类型：
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作者：
Feldman, Candace H.;Malspeis, Susan;Roberts, Andrea L.
Objective.暴露于严重的应激源可能会改变免疫功能，增加炎症和细胞因子释放，增加自身免疫性疾病的风险。我们研究了儿童期虐待是否与系统性红斑狼疮（SLE）事件的高风险有关。数据来自护士健康研究II，1989年登记的美国女护士队列，随后两年一次的问卷调查。我们测量了儿童期的身体和情感虐待的儿童创伤问卷的身体和情感虐待分量表和性虐待的亲子冲突策略量表，在2001年管理的性虐待量表。我们确定了截至2015年的SLE事件（>= 4美国流变学会1997年分类标准）。我们使用多变量考克斯回归模型来评估儿童期虐待与SLE之间的关系，考虑到潜在的混杂因素（例如，父母教育、职业、自置居所）和调解人（例如，抑郁症、创伤后应激障碍（PTSD）]。在67，516名妇女中，有94例SLE事件。在调整后的模型中，暴露于最高和最低的身体和精神虐待与SLE风险增加2.57倍相关（95%CI 1.30-5.12）。我们发现，17%（p < 0.0001）与虐待相关的SLE风险可以用抑郁症解释，23%（p < 0.0001）可以用创伤后应激障碍解释。我们没有观察到与性虐待的统计学显著相关性（HR 0.84，95% CI 0.40-1.77，最高与最低暴露）。我们观察到，与没有经历过童年期身体和情感虐待的女性相比，有过童年期身体和情感虐待的女性患SLE的风险显著增加。童年经历逆境可能会导致系统性红斑狼疮的发生。
Objective. Exposure to severe stressors may alter immune function and augment inflammation and cytokine release, increasing risk of autoimmune disease. We examined whether childhood abuse was associated with a heightened risk of incident systemic lupus erythematosus (SLE).Methods. Data were drawn from the Nurses' Health Study II, a cohort of US female nurses enrolled in 1989, followed with biennial questionnaires. We measured childhood physical and emotional abuse with the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire and sexual abuse with the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scale, both administered in 2001. We identified incident SLE (>= 4 American College of Rheumatology 1997 classification criteria) through 2015. We used multivariable Cox regression models to evaluate the association between childhood abuse and SLE, accounting for potential confounders (e.g., parental education, occupation, home ownership) and mediators [e.g., depression, posttraumatic stress disorder (PTSD)].Results. Among 67,516 women, there were 94 cases of incident SLE. In adjusted models, exposure to the highest versus lowest physical and emotional abuse was associated with 2.57 times greater risk of SLE (95% CI 1.30-5.12). We found that 17% (p < 0.0001) of SLE risk associated with abuse could be explained by depression and 23% (p < 0.0001) by PTSD. We did not observe a statistically significant association with sexual abuse (HR 0.84, 95% CI 0.40-1.77, highest vs lowest exposure).Conclusion. We observed significantly increased risk of SLE among women who had experienced childhood physical and emotional abuse compared with women who had not. Exposure to childhood adversity may contribute to development of SLE.