Systemic Autoimmune Disease Among Adults Exposed to the September 11, 2001 Terrorist Attack
Systemic Autoimmune Disease Among Adults Exposed to the September 11, 2001 Terrorist Attack
复制标题
DOI：
10.1002/art.41175
复制
发表时间：
2020-04-01
影响因子：
13.3
通讯作者：
Cone, James E.
中科院分区：
文献类型：
--
作者：
Miller-Archie, Sara A.;Izmirly, Peter M.;Cone, James E.
目的自身免疫性疾病是2001年9月11日世界贸易中心（WTC）袭击事件暴露人群中的一种新疾病。世贸中心倒塌产生的尘埃云的成分与系统性自身免疫性疾病的发展有关，创伤后应激障碍（PTSD）也是如此。我们进行了这项研究，以确定是否粉尘暴露和创伤后应激障碍与系统性自身免疫性疾病的风险增加，在9/11暴露cohol.Methods在43,133世贸中心健康注册登记，2,786自我报告有一个后9/11系统性自身免疫性疾病。我们获得了知情同意书，以审查医疗记录，以验证1，041名入组者的系统性自身免疫性疾病诊断。系统性自身免疫性疾病的诊断通过分类标准、风湿病学家诊断或已开具系统性自身免疫性疾病药物来确认。对照组为否认自身免疫性疾病诊断的入组者（n = 37，017）。我们使用多变量对数二项回归来检查多次9/11暴露与9/11后全身性自身免疫性疾病风险之间的关联，按响应者（救援，恢复和清理工作者）和社区成员（例如，结果共确诊系统性自身免疫病118例。风湿性关节炎最常见（n = 71），其次是干燥综合征（n = 22）、系统性红斑狼疮（n = 20）、肌炎（n = 9）、混合性结缔组织病（n = 7）和硬皮病（n = 4）。在9/11的应答者中，那些有强烈尘云暴露的人患全身性自身免疫性疾病的风险几乎是对照组的两倍（调整后的风险比为1.86 [95%置信区间为1.02-3.40]）。社区成员与PTSD有近3倍的全身性自身免疫性疾病的风险增加。结论强烈的粉尘云暴露之间的反应者和社区成员之间的PTSD与新发全身性自身免疫性疾病的风险增加有统计学意义。治疗9/11幸存者的临床医生应该意识到这一人群中全身性自身免疫性疾病的潜在风险增加。
Objective Autoimmune disease is an emerging condition among persons exposed to the September 11, 2001 attack on the World Trade Center (WTC). Components of the dust cloud resulting from the collapse of the WTC have been associated with development of a systemic autoimmune disease, as has posttraumatic stress disorder (PTSD). We undertook this study to determine whether dust exposure and PTSD were associated with an increased risk of systemic autoimmune disease in a 9/11-exposed cohort.Methods Among 43,133 WTC Health Registry enrollees, 2,786 self-reported having a post-9/11 systemic autoimmune disease. We obtained informed consent to review medical records to validate systemic autoimmune disease diagnoses for 1,041 enrollees. Diagnoses of systemic autoimmune diseases were confirmed by classification criteria, rheumatologist diagnosis, or having been prescribed systemic autoimmune disease medication. Controls were enrollees who denied having an autoimmune disease diagnosis (n = 37,017). We used multivariable log-binomial regression to examine the association between multiple 9/11 exposures and risk of post-9/11 systemic autoimmune disease, stratifying by responders (rescue, recovery, and clean-up workers) and community members (e.g., residents, area workers).Results We identified 118 persons with systemic autoimmune disease. Rheumatoid arthritis was most frequent (n = 71), followed by Sjogren's syndrome (n = 22), systemic lupus erythematosus (n = 20), myositis (n = 9), mixed connective tissue disease (n = 7), and scleroderma (n = 4). Among 9/11 responders, those with intense dust cloud exposure had almost twice the risk of systemic autoimmune disease (adjusted risk ratio 1.86 [95% confidence interval 1.02-3.40]). Community members with PTSD had a nearly 3-fold increased risk of systemic autoimmune disease.Conclusion Intense dust cloud exposure among responders and PTSD among community members were associated with a statistically significant increased risk of new-onset systemic autoimmune disease. Clinicians treating 9/11 survivors should be aware of the potential increased risk of systemic autoimmune disease in this population.