Allergic diseases and long-term risk of autoimmune disorders: longitudinal cohort study and cluster analysis
Allergic diseases and long-term risk of autoimmune disorders: longitudinal cohort study and cluster analysis
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DOI：
10.1183/13993003.00476-2019
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发表时间：
2019-11-01
影响因子：
24.3
通讯作者：
Nirantharakumar, Krishnarajah
中科院分区：
文献类型：
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作者：
Krishna, Mamidipudi Thirumala;Subramanian, Anuradhaa;Nirantharakumar, Krishnarajah
导言：过敏性疾病与自身免疫性疾病之间的关系尚未得到很好的证实。我们的目的是确定自身免疫性疾病在变应性鼻炎/结膜炎（ARC）、特应性湿疹和哮喘中的发病率，并调查其共同发生的模式。方法：这是一项回顾性队列研究（1990-2018），数据提取自The Health Improvement Network（英国初级保健数据库）。暴露组包括ARC、特应性湿疹和哮喘（所有年龄段）。对于每个暴露的患者，最多随机选择两名年龄和性别匹配的对照组，没有记录过敏疾病。校正发病率比（airr）采用泊松回归计算。还采用关联规则挖掘（ARM）进行了横断面研究，以调查疾病群集。结果：共纳入ARC患者782 320例，特应性湿疹患者1 393570例，哮喘患者1 049 868例。系统性红斑狼疮（SLE）、干燥综合征、白癜风、类风湿性关节炎、牛皮癣、恶性贫血、炎症性肠病、乳糜泻和自身免疫性甲状腺炎的airr均高于对照组。具体而言，SLE（1.45）和干燥综合征（1.88）的airr在ARC中更高；SLE（1.44）、干燥综合征（1.61）和重症肌无力（1.56）的airr高于哮喘；SLE（1.86）、干燥综合征（1.48）、白癜风（1.54）、牛皮癣（2.41）的airr均高于特应性湿疹。三种变应性疾病对多发性硬化症、ARC和特应性湿疹对肌无力无显著影响。使用ARM，过敏性疾病与多种自身免疫性疾病聚集在一起。发现了三个年龄和性别相关的群集，其中55岁以下女性的模式相对复杂。结论：变应性疾病患者发生自身免疫性疾病的长期风险显著增高。过敏性疾病和自身免疫性疾病表现出年龄和性别相关的聚类模式。
Introduction: The association between allergic diseases and autoimmune disorders is not well established. Our objective was to determine incidence rates of autoimmune disorders in allergic rhinitis/conjunctivitis (ARC), atopic eczema and asthma, and to investigate for co-occurring patterns.Methods: This was a retrospective cohort study (1990-2018) employing data extracted from The Health Improvement Network (UK primary care database). The exposure group comprised ARC, atopic eczema and asthma (all ages). For each exposed patient, up to two randomly selected age- and sex-matched controls with no documented allergic disease were used. 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 393570 and 1 049 868 patients with ARC, atopic eczema and asthma, respectively, were included. aIRRs of systemic lupus erythematosus (SLE), Sjogren's syndrome, vitiligo, rheumatoid arthritis, psoriasis, pernicious anaemia, inflammatory bowel disease, coeliac disease and autoimmune thyroiditis were uniformly higher in the three allergic diseases compared with controls. Specifically, aIRRs of SLE (1.45) and Sjogren's syndrome (1.88) were higher in ARC; aIRRs of SLE (1.44), Sjogren's syndrome (1.61) and myasthenia (1.56) were higher in asthma; and aIRRs of SLE (1.86), Sjogren's syndrome (1.48), vitiligo (1.54) and psoriasis (2.41) were higher in atopic eczema. There was no significant effect of the three allergic diseases on multiple sclerosis or of ARC and atopic eczema on myasthenia. Using ARM, allergic diseases clustered with multiple autoimmune disorders. Three age- and sex-related clusters were identified, with a relatively complex pattern in females >= 55 years old.Conclusions: The long-term risks of autoimmune disorders are significantly higher in patients with allergic diseases. Allergic diseases and autoimmune disorders show age- and sex-related clustering patterns.