Occupational exposure in ANCA-positive patients:: A case-control study
Occupational exposure in ANCA-positive patients:: A case-control study
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DOI：
10.1111/j.1523-1755.2005.00295.x
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发表时间：
2005-05-01
影响因子：
19.6
通讯作者：
Büchler, M
中科院分区：
文献类型：
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作者：
Beaudreuil, S;Lasfargues, G;Büchler, M
背景。抗中性粒细胞胞浆自身抗体（ANCA）是小血管炎诊断和随访的重要生物标志物。ANCA的作用尚未完全确定，但遗传、传染和/或环境因素可能增加对这些疾病的易感性。我们进行了一项流行病学研究，以调查ANCA的存在是否与二氧化硅或任何其他形式的职业暴露有关，而不考虑潜在疾病。纳入了1990年至2000年间在该机构免疫学实验室记录的所有连续的anca阳性患者。选择年龄和性别相匹配的内科住院患者作为对照（2例对照/例）。定性和半定量的职业暴露和吸烟习惯分析由5名专家盲诊断。单因素分析显示，报告粉尘暴露的患者出现anca阳性的风险高出2.6 (P = 0.007)（优势比2.6;95% CI 1.3至5.3），专业接触二氧化硅的患者出现anca阳性的风险高出3.4 (P = 0.03)（优势比3.4;95% CI 1.1至9.9）。其他环境因素或吸烟习惯在anca阳性患者和对照组之间没有差异。细胞质ANCA （c-ANCA）、核周ANCA （p-ANCA）或非典型ANCA患者的二氧化硅暴露量没有差异。半定量分析显示，与对照组相比，二氧化硅暴露的剂量效应使anca阳性的风险增加了近7倍（P = 0.02）（优势比为6.9；95% CI为1.3至35.1）。这些结果支持了血浆中ANCA的存在可能至少部分与职业暴露有关的假设。
Background. Antineutrophil cytoplasmic autoantibodies (ANCA) are valuable biomarkers for the diagnosis and follow-up of small vessel vasculitis. The role of ANCA has not yet been fully established, but genetic, infectious, and/or environmental factors may increase susceptibility to these diseases. We performed an epidemiologic study to investigate whether the presence of ANCA was associated with silica or any other form of occupational exposure, regardless of the underlying disease.Methods. All consecutive ANCA-positive patients recorded at the institution's Laboratory of Immunology between 1990 and 2000 were included. Patients hospitalized in a unit of internal medicine matched for age and gender were selected as controls (two controls/case). Qualitative and semiquantitative professional exposure and smoking habits were analyzed by five experts blind to the diagnosis.Results. Univariate analysis showed that patients who reported dust exposure had a 2.6 greater risk of being ANCA-positive (P = 0.007) (odds ratio 2.6; 95% CI 1.3 to 5.3) and individuals with professional exposure to silica had a 3.4 higher risk of being ANCA-positive (P = 0.03) (odds ratio 3.4; 95% CI 1.1 to 9.9). None of the other environmental factors or smoking habits were different between ANCA-positive patients and controls. There was no difference in silica exposure between patients with cytoplasmic ANCA (c-ANCA), perinuclear ANCA (p-ANCA), or atypical ANCA.Semiquantitative analysis showed a dose effect of silica exposure with a nearly sevenfold greater risk of being ANCA-positive compared to controls (P = 0.02) (odds ratio 6.9; 95% CI 1.3 to 35.1).Conclusion. These results support the hypothesis that the presence of ANCA in plasma might at least partially be related to occupational exposure.