Autoimmune and chronic inflammatory disorders and risk of non-Hodgkin lymphoma by subtype
Autoimmune and chronic inflammatory disorders and risk of non-Hodgkin lymphoma by subtype
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DOI：
10.1093/jnci/djj004
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发表时间：
2006-01-04
影响因子：
10.3
通讯作者：
Adami, HO
中科院分区：
文献类型：
--
作者：
Smedby, KE;Hjalgrim, H;Adami, HO
背景一些自身免疫性和慢性炎症性疾病与非霍奇金淋巴瘤（NHL）的风险增加有关。由于不同的NHL亚型在淋巴细胞分化的不同阶段发展，自身免疫性疾病和炎症性疾病与特定NHL亚型的关联可能导致更好地理解淋巴瘤发生机制。研究方法：在丹麦和瑞典进行的一项基于人群的病例对照研究中，3055名NHL患者和3187名匹配的对照受试者被问及自身免疫性和慢性炎症性疾病的病史、严重程度标志物和治疗情况。采用Logistic回归并调整研究匹配因素，计算NHL总体和NHL亚型的比值比（OR）和95%置信区间（CI）。结果如下：所有NHL的风险增加与类风湿性关节炎（OR = 1.5，95%CI = 1.1 ~ 1.9），原发性干燥综合征（OR = 6.1，95%CI = 1.4至27）、系统性红斑狼疮（OR = 4.6，95%CI = 1.0至22）和乳糜泻（OR = 2.1，95%CI = 1.0至4.8）。所有这些情况也与弥漫性大B细胞淋巴瘤有关，有些与边缘区、淋巴浆细胞或T细胞淋巴瘤有关。曾使用非甾体类抗炎药、全身性皮质类固醇和选定的免疫抑制剂与类风湿性关节炎患者发生NHL的风险相关，但与未患类风湿性关节炎的受试者无关。此外，治疗的多变量调整对风险估计的影响很小。银屑病、结节病和炎症性肠病与NHL总体或任何NHL亚型的风险增加无关。结论：我们的研究结果证实了某些自身免疫性疾病和NHL风险之间的关联，并表明这种关联可能不是普遍的，而是通过特定的NHL亚型介导的。这些NHL亚型在淋巴细胞分化的抗原暴露后阶段发展，与抗原驱动在自身免疫相关淋巴瘤发生中的作用一致。
Background. Some autoimmune and chronic inflammatory disorders are associated with increased risks of non-Hodgkin lymphoma (NHL). Because different NHL subtypes develop at different stages of lymphocyte differentiation, associations of autoimmune and inflammatory disorders with specific NHL subtypes could lead to a better understanding of lymphomagenic mechanisms. Methods: In a population-based case-control study in Denmark and Sweden, 3055 NHL patients and 3187 matched control subjects were asked about their history of autoimmune and chronic inflammatory disorders, markers of severity, and treatment. Logistic regression with adjustment for study matching factors was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for NHL overall and for NHL subtypes. Results: Risks of all NHL were increased in association with rheumatoid arthritis (OR = 1.5, 95% CI = 1.1 to 1.9), primary Sjogren syndrome (OR = 6.1, 95% CI = 1.4 to 27), systemic lupus erythernatosus (OR = 4.6, 95% CI = 1.0 to 22), and celiac disease (OR = 2.1, 95% CI = 1.0 to 4.8). All of these conditions were also associated with diffuse large B-cell lymphoma, and some were associated with marginal zone, lymphoplasmacytic, or T-cell lymphoma. Ever use of nonsteroidal anti-inflammatory drugs, systemic corticosteroids, and selected immunosuppressants was associated with risk of NHL in rheumatoid arthritis patients but not in subjects without rheumatoid arthritis. Also, multivariable adjustment for treatment had little impact on risk estimates. Psoriasis, sarcoidosis, and inflammatory bowel disorders were not associated with increased risk of NHL overall or of any NHL subtype. Conclusions: Our results confirm the associations between certain autoimmune disorders and risk of NHL and suggest that the associations may not be general but rather mediated through specific NHL subtypes. These NHL subtypes develop during postantigen exposure stages of lymphocyte differentiation, consistent with a role of antigenic drive in autoimmunity-related lymphomagenesis.