Clinical and Immunological Characteristics of Autoimmune Addison Disease: A Nationwide Swedish Multicenter Study
Clinical and Immunological Characteristics of Autoimmune Addison Disease: A Nationwide Swedish Multicenter Study
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DOI：
10.1210/jc.2016-2522
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发表时间：
2017-02-01
影响因子：
5.8
通讯作者：
Bensing, Sophie
中科院分区：
文献类型：
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作者：
Dalin, Frida;Eriksson, Gabriel Nordling;Bensing, Sophie
背景：需要对自身免疫性艾迪生病 (AAD) 的临床和免疫学特征进行研究，以了解疾病负担和死亡率增加。目的：提供有关自身免疫合并症、替代治疗、自身抗体谱和心血管危险因素的最新数据。设计、设置和参与者：一项横断面、基于人群的研究，包括来自瑞典艾迪生病登记处的 660 名 AAD 患者（2008-2014 年）。在分析心血管危险因素时，来自瑞典北部 MONICA（心血管疾病趋势和决定因素监测）的人口调查的 3594 名个体作为对照。 主要结果指标：终点是自身免疫合并症和心血管危险因素的患病率。测定针对13种自身抗原的自身抗体。结果：21-羟化酶自身抗体阳性的患者比例为83%，其中62%的患者患有≥1种相关自身免疫性疾病，且多见于女性（P,0.0001）。与对照组相比，AAD 患者的体重指数 (P, 0.0001) 和高血压患病率较低 (P = 0.027)。 89%的患者使用传统氢化可的松片剂，平均剂量为28.1+/-8.5mg/d。标准化至体表的平均氢化可的松当量剂量为 14.8 +/- 4.4 mg/m(2)/d。氢化可的松当量剂量越大，高血压发病率越高（P = 0.046）。结论：有必要仔细监测 AAD 患者，以发现相关的自身免疫性疾病。当代瑞典 AAD 患者超重、高血压、2 型糖尿病或高脂血症的患病率并未增加。然而，高糖皮质激素替代剂量可能是高血压的危险因素。
Context: Studies of the clinical and immunological features of autoimmune Addison disease (AAD) are needed to understand the disease burden and increased mortality.Objective: To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles, and cardiovascular risk factors.Design, Setting, and Participants: A cross-sectional, population-based study that included 660 AAD patients from the Swedish Addison Registry (2008-2014). When analyzing the cardiovascular risk factors, 3594 individuals from the population-based survey in Northern Sweden, MONICA (monitoring of trends and determinants of cardiovascular disease), served as controls.Main Outcome Measures: The endpoints were the prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.Results: The proportion of 21-hydroxylase autoantibody-positive patients was 83%, and 62% of patients had >= 1 associated autoimmune diseases, more frequently coexisting in females (P, 0.0001). AAD patients had a lower body mass index (P, 0.0001) and prevalence of hypertension (P = 0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of the patients, with a mean dose of 28.1 +/- 8.5 mg/d. The mean hydrocortisone equivalent dose normalized to the body surface was 14.8 +/- 4.4 mg/m(2)/d. A greater hydrocortisone equivalent dose was associated with a greater incidence of hypertension (P = 0.046).Conclusions: Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients did not have an increased prevalence of overweight, hypertension, type 2 diabetes mellitus, or hyperlipidemia. However, high glucocorticoid replacement doses could be a risk factor for hypertension.