The autoimmune spectrum of myasthenia gravis: a Swedish population-based study
The autoimmune spectrum of myasthenia gravis: a Swedish population-based study
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DOI：
10.1111/joim.12310
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发表时间：
2015-05-01
影响因子：
11.1
通讯作者：
Piehl, F.
中科院分区：
文献类型：
--
作者：
Fang, F.;Sveinsson, O.;Piehl, F.
目的确定重症肌无力（MG）的患病率和并发自身免疫性疾病的发生率与MG患者。设计和设置使用瑞典健康和人口登记，在2005-2010年期间，我们进行了一项巢式病例对照研究的MG患者（n=2045）与5个年龄和性别匹配的人口为基础的控制每例。在斯德哥尔摩MG队列中验证了基于登记的MG诊断。类似的巢式病例对照研究在多发性硬化症（MS）患者中进行，作为神经炎性疾病对照，以及MG患者的同胞。主要结果测量比值比（OR）及其95%置信区间（CI）计算作为MG与其他自身免疫性疾病之间关联的测量。与对照组相比，MG患者发生另一种自身免疫性疾病的风险增加（22.0% vs. 8.9%; OR：2.82，95%CI：2.49-3.20）;这种风险在年轻人和女性中更强。多发性肌炎/皮肌炎、系统性红斑狼疮和Addison病这三种受HLA-B8-DR 3单倍型调控的疾病与MG，尤其是早发性疾病的相关性最强。斯德哥尔摩MG队列的HLA分型显示早发MG确实以HLA-B8-DR 3为主。另一种自身免疫性疾病的风险增加MS患者和MG患者的兄弟姐妹，与他们各自的控制相比，但在较小的程度上比MG患者。ConclusionsOur结果表明，MG与其他自身免疫性疾病的风险因素，在更大的程度上比MS，特别是在年轻和女性患者的HLA-B8-DR 3单倍型的作用。
ObjectivesTo determine the prevalence of myasthenia gravis (MG) and the rate of concurrent autoimmune diseases in patients with MG.Design and settingUsing the Swedish health and population registers, during the period 2005-2010, we conducted a nested case-control study of patients with MG (n=2045) with five age- and sex-matched population-based controls per case. Register-based MG diagnosis was validated against the Stockholm MG Cohort. Similar nested case-control studies were conducted in patients with multiple sclerosis (MS), as a neuroinflammatory disease control, and siblings of patients with MG.Main outcome measureOdds ratios (ORs) and their 95% confidence intervals (CIs) were calculated as a measure of the association between MG and other autoimmune diseases.ResultsThe prevalence of MG was 24.8/100000, and patients with MG had an increased risk of another autoimmune disease compared to controls (22.0% vs. 8.9%; OR: 2.82, 95% CI: 2.49-3.20); this risk was stronger amongst younger persons and women. Polymyositis/dermatomyositis, systemic lupus erythematosus and Addison's disease, three conditions regulated by the HLA-B8-DR3 haplotype, were most strongly associated with MG, especially early-onset disease. HLA typing in the Stockholm MG Cohort showed that early-onset MG was indeed dominated by HLA-B8-DR3. The risk of another autoimmune disease was increased in both patients with MS and siblings of patients with MG, compared to their respective controls, but to a lesser extent than in patients with MG.ConclusionsOur results suggest that MG shares risk factors with other autoimmune diseases, to a greater degree than MS, with a particular role of the HLA-B8-DR3 haplotype, especially amongst younger and female patients.