Sturkenboom M C, Meier C R, Jick H, Stricker B H
Pharmacoepidemiology Unit, Erasmus University Medical School, Rotterdam, The Netherlands.
Arch Intern Med. 1999 Mar 8;159(5):493-7. doi: 10.1001/archinte.159.5.493.
Recently several case reports described the association between minocycline and lupuslike syndrome. Minocycline, one of the tetracyclines, is widely used to treat acne. We aimed to examine the association of exposure to minocycline and other tetracyclines with the development of lupuslike syndrome.
We conducted a nested case-control study in a cohort of 27 688 acne patients aged 15 to 29 years, using data automatically recorded on general practitioners' office computers in the United Kingdom. Controls were matched to cases on age, sex, and practice. The main outcome was lupuslike syndrome defined as the occurrence of polyarthritis or polyarthralgia of unknown origin, with negative rheumatoid factor or latex agglutination test, positive or unmeasured antinuclear factor, elevated or unmeasured erythrocyte sedimentation rate, and absence of or unmeasured antinative DNA antibody levels.
We identified 29 cases and selected 152 controls. Current single use of minocycline was associated with an 8.5-fold (95% confidence interval [CI], 2.1-35) increased risk of developing lupuslike syndrome compared with non-users and past users of tetracyclines combined. The risk of past exposure to any of the tetracyclines was closely similar to nonuse (relative risk, 1.3; 95% CI, 0.5-3.3). Current use of doxycycline, oxytetracycline, or tetracycline combined was associated with a 1.7-fold (95% CI, 0.4-8.1) increase of risk. The risk increased with longer use.
Current use of minocycline increased the risk of developing lupuslike syndrome 8.5-fold in the cohort of young acne patients. The effect was stronger in longer-term users. However, the absolute risk of developing lupuslike syndrome seems to be relatively low.
最近有几例病例报告描述了米诺环素与狼疮样综合征之间的关联。米诺环素是四环素类药物之一，广泛用于治疗痤疮。我们旨在研究接触米诺环素和其他四环素类药物与狼疮样综合征发生之间的关联。
我们在一个由27688名年龄在15至29岁的痤疮患者组成的队列中进行了一项巢式病例对照研究，使用英国全科医生办公室计算机自动记录的数据。对照组在年龄、性别和执业地点方面与病例进行匹配。主要结局是狼疮样综合征，定义为不明原因的多关节炎或多关节痛的发生，类风湿因子或乳胶凝集试验阴性，抗核因子阳性或未检测，红细胞沉降率升高或未检测，以及抗天然DNA抗体水平缺失或未检测。
我们确定了29例病例并选择了152名对照。与四环素类药物的非使用者和既往使用者相比，当前单独使用米诺环素与发生狼疮样综合征的风险增加8.5倍（95%置信区间[CI]，2.1-35）相关。既往接触任何一种四环素类药物的风险与未接触者密切相似（相对风险，1.3；95%CI，0.5-3.3）。当前联合使用多西环素、土霉素或四环素与风险增加1.7倍（95%CI，0.4-8.1）相关。风险随着使用时间的延长而增加。
在年轻痤疮患者队列中，当前使用米诺环素使发生狼疮样综合征的风险增加8.5倍。长期使用者的影响更强。然而，发生狼疮样综合征的绝对风险似乎相对较低。
