Association of Stress-Related Disorders With Subsequent Autoimmune Disease
Association of Stress-Related Disorders With Subsequent Autoimmune Disease
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DOI：
10.1001/jama.2018.7028
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发表时间：
2018-06-19
影响因子：
120.7
通讯作者：
Valdimarsdottir, Unnur A.
中科院分区：
文献类型：
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作者：
Song, Huan;Fang, Fang;Valdimarsdottir, Unnur A.
重要性精神反应在一般人群中很常见，可能会导致免疫功能障碍。这些反应是否会导致自身免疫性疾病的风险尚不清楚。目的确定应激相关疾病和随后的自身免疫性疾病之间是否存在关联。设计、背景和参与者于1981年1月1日至2013年12月31日在瑞典进行了一项人群和兄弟姐妹匹配的回顾性队列研究。队列包括106 464名暴露于应激相关障碍的患者，1 064 640名匹配的非暴露者和126 652名这些患者的完整兄弟姐妹。外展诊断应激相关障碍，即创伤后应激障碍、急性应激反应、适应障碍和其他应激反应。通过国家患者登记确定应激相关障碍和自身免疫性疾病的结果和测量。在控制了多个危险因素的情况下，用Cox模型估计了41种自身免疫性疾病在诊断应激相关疾病后1年以上95%的CI的风险比(HRs)。结果应激相关疾病确诊时的中位年龄为41岁(四分位数范围33-50岁)，40%的暴露患者为男性。在平均10年的随访中，暴露组、匹配非暴露组和兄弟姐妹队列中自身免疫性疾病的发病率分别为9.1、6.0和6.5/1000人年(与基于人口和兄弟姐妹的参考组相比，绝对比率差异分别为3.12[95%CI，2.99-3.25]和2.49[95%CI，2.23-2.76])。与非暴露人群相比，患有应激相关疾病的患者患自身免疫性疾病的风险增加(HR，1.36[95%CI，1.33-1.40])。创伤后应激障碍患者任何一种疾病的RR为1.46(95%CI，1.32~1.61)，多种自身免疫性疾病的HR为2.29(95%CI，1.72~3.04)。这些关联在基于兄弟姐妹的比较中是一致的。在年龄=51岁的年轻患者中，相对风险升高更为明显(HR，1.48[95%CI，1.42-1.55]；1.41[95%CI，1.33-1.48]；1.31[95%CI，1.24-1.37]；和1.23[95%CI，1.17-1.30]；P
IMPORTANCE Psychiatric reactions to life stressors are common in the general population and may result in immune dysfunction. Whether such reactions contribute to the risk of autoimmune disease remains unclear.OBJECTIVE To determine whether there is an association between stress-related disorders and subsequent autoimmune disease.DESIGN, SETTING, AND PARTICIPANTS Population-and sibling-matched retrospective cohort study conducted in Sweden from January 1, 1981, to December 31, 2013. The cohort included 106 464 exposed patients with stress-related disorders, with 1 064 640 matched unexposed persons and 126 652 full siblings of these patients.EXPOSURES Diagnosis of stress-related disorders, ie, posttraumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions.MAIN OUTCOMES AND MEASURES Stress-related disorder and autoimmune diseaseswere identified through the National Patient Register. The Cox model was used to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors.RESULTS The median age at diagnosis of stress-related disorders was 41 years (interquartile range, 33-50 years) and 40% of the exposed patients were male. During a mean follow-up of 10 years, the incidence rate of autoimmune diseases was 9.1, 6.0, and 6.5 per 1000 person-years among the exposed, matched unexposed, and sibling cohorts, respectively (absolute rate difference, 3.12 [95% CI, 2.99-3.25] and 2.49 [95% CI, 2.23-2.76] per 1000 person-years compared with the population-and sibling-based reference groups, respectively). Compared with the unexposed population, patients with stress-related disorders were at increased risk of autoimmune disease (HR, 1.36 [95% CI, 1.33-1.40]). The HRs for patients with posttraumatic stress disorder were 1.46 (95% CI, 1.32-1.61) for any and 2.29 (95% CI, 1.72-3.04) for multiple (>= 3) autoimmune diseases. These associations were consistent in the sibling-based comparison. Relative risk elevations were more pronounced among younger patients (HR, 1.48 [ 95% CI, 1.42-1.55]; 1.41 [ 95% CI, 1.33-1.48]; 1.31 [ 95% CI, 1.24-1.37]; and 1.23 [95% CI, 1.17-1.30] for age at = 51 years, respectively; P for interaction