A review on SLE and malignancy.
A review on SLE and malignancy.
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DOI：
10.1016/j.berh.2017.09.013
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发表时间：
2017-06
期刊：
影响因子：
--
通讯作者：
Clarke AE
中科院分区：
文献类型：
--
作者：
Choi MY;Flood K;Bernatsky S;Ramsey-Goldman R;Clarke AE
系统性红斑狼疮(SLE)是一种以自身抗体产生、补体激活和免疫复合物沉积为特征的慢性系统性自身免疫性疾病。它主要影响年轻和中年女性。虽然系统性红斑狼疮诊断和治疗的改进改变了预后，但发病率和死亡率仍然高于普通人群。除了肾脏损伤、心血管疾病和感染外，恶性肿瘤也是这一人群死亡的重要原因。越来越多的证据表明，系统性红斑狼疮患者的总体恶性风险略高。系统性红斑狼疮恶变的风险是相当感兴趣的，因为SLE发病机制的免疫和遗传途径以及在其治疗中使用的免疫抑制药物(ISDS)可能调节这种改变的风险。我们目前对这些和其他危险因素的理解以及对SLE治疗和恶性肿瘤筛查的影响仍在发展中。本文就系统性红斑狼疮与恶性肿瘤的关系作一综述。第一部分将讨论成人和儿童发病的系统性红斑狼疮的整体和特定部位恶性肿瘤的风险。接下来，我们评估恶性肿瘤和SLE之间潜在的危险因素和可能的机制，包括ISDS的使用，某些SLE相关自身抗体的存在，慢性免疫失调，环境因素，以及共同的遗传易感性。最后，我们回顾了关于癌症筛查和人类乳头瘤病毒(HPV)疫苗接种的指南。
Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease characterized by autoantibody production, complement activation, and immune complex deposition. It predominantly affects young and middle-aged women. While improvements in the diagnosis and treatment of SLE have altered prognosis, morbidity and mortality rates remain higher than the general population. In addition to renal injury, cardiovascular disease, and infection, malignancy is known to be a significant cause of death in this population. There is increasing evidence to suggest that patients with SLE have a slightly higher overall risk of malignancy. The risk of malignancy in SLE is of considerable interest because the immune and genetic pathways underlying the pathogenesis of SLE as well as the immunosuppressant drugs (ISDs) used in its management may mediate this altered risk. Our current understanding of these and other risk factors and the implications for treating SLE and screening for malignancy is still evolving. This review summarizes the association between SLE and malignancy. The first section will discuss the risk of overall and site-specific malignancies in both adult and pediatric-onset SLE. Next, we evaluate the risk factors and possible mechanisms underlying the link between malignancy and SLE, including the use of ISDs, presence of certain SLE-related autoantibodies, chronic immune dysregulation, environmental factors, and shared genetic susceptibility. Finally, we review guidelines regarding cancer screening and vaccination for human papilloma virus (HPV).
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