Combined Oral Contraceptive Use and the Risk of Systemic Lupus Erythematosus
Combined Oral Contraceptive Use and the Risk of Systemic Lupus Erythematosus
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DOI：
10.1002/art.24398
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发表时间：
2009-04-15
期刊：
影响因子：
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通讯作者：
Suissa, Samy
中科院分区：
文献类型：
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作者：
Bernier, Marie-Odile;Mikaeloff, Yann;Suissa, Samy
Objective.评估系统性红斑狼疮（SLE）的发病风险是否与联合口服避孕药（COCs）的使用有关，因为外源性激素暴露与SLE发病风险之间的联系的研究产生了相互矛盾的结果。我们使用英国全科医学研究数据库，在18-45岁的女性中进行了一项基于人群的巢式病例对照研究。从1994年至2004年的所有SLE发病病例（n = 786）均在数据库中确定，并与10名确诊时无SLE的女性对照组（n = 7，817）进行匹配。与任何使用COC相关的SLE事件的校正率比（RR）为1.19（95%置信区间[95% CI] 0.98-1.45），而当前使用为1.54（95% CI 1.15-2.07）。与长期使用者（RR 1.45，95% CI 1.06-1.99）相比，最近才开始使用COC的当前使用者（RR 2.52，95% CI 1.14-5.57）的发生率尤其增加。目前使用第一代或第二代避孕药的风险似乎特别高（RR 1.65，95% CI 1.20-2.26），并随着炔雌醇剂量的增加而增加（RR 1.42，1.63和2.92，
Objective. To assess whether the risk of incident systemic lupus erythematosus (SLE) is associated with the use of combined oral contraceptives (COCs), because studies of the link between exogenous hormonal exposure and the risk of SLE have produced conflicting results.Methods. We conducted a population-based nested case-control study among women ages 18-45 years, using the UK's General Practice Research Database. All incident cases of SLE from 1994-2004 (n = 786) were identified in the database and matched with up to 10 controls (n = 7,817) among women without SLE at the time of the case's diagnosis.Results. The adjusted rate ratio (RR) of incident SLE associated with any use of COC was 1.19 (95% confidence interval [95% CI] 0.98-1.45), whereas with current use it was 1.54 (95% CI 1.15-2.07). The rate was particularly increased in current users who had only recently started COC use (RR 2.52, 95% CI 1.14-5.57) compared with longer-term current users (RR 1.45, 95% CI 1.06-1.99). The risk appeared to be particularly elevated with current exposure to first- or second-generation contraceptives (RR 1.65, 95% CI 1.20-2.26), and increasing with the dose of ethinyl estradiol (RR 1.42, 1.63, and 2.92 for