Uribe América G, McGwin Gerald, Reveille John D, Alarcón Graciela S
Department of Medicine (Division of Clinical Immunology and Rheumatology), School of Medicine and Public Health, The University of Alabama at Birmingham, 510 20th Street South 830 FOT, Birmingham, AL 35294, USA.
Autoimmun Rev. 2004 Jun;3(4):321-9. doi: 10.1016/j.autrev.2003.11.005.
Recently, there has been an awareness of the variable phenotypic expression of numerous disorders between individuals from different ethnicities, systemic lupus erythematosus (SLE) one of them. These disparities probably arise from the interaction between genetic and non-genetic (environmental, socioeconomic-demographic, cultural and behavioral) factors. To delineate the influence of these factors on SLE outcome, we established a multiethnic (Hispanic, African American and Caucasian) United States (US) early cohort (<5 years disease duration). Ten years later, interesting data have emerged from the LUMINA (Lupus in Minorities: Nature vs. nurture) cohort. For example, African Americans and Hispanics from Texas have a more severe disease than Caucasians and Hispanics from Puerto Rico. Lack of private insurance, acute SLE onset, expression of HLA-DRB101 (DR1) and C4A3 alleles were associated with higher disease activity, whereas age, the number of American College of Rheumatology criteria met, disease activity, corticosteroid use and abnormal illness behaviors were consistent predictors of damage. In turn, damage and poverty were found to predict mortality. We now plan to apply new approaches (genetic admixture) to deconfound the complex interaction between genetic and non-genetic factors influencing SLE outcome. These data may have impact on the development of policies aimed at eliminating health disparities in the US.
最近，人们已经意识到许多疾病在不同种族个体之间存在可变的表型表达，系统性红斑狼疮（SLE）就是其中之一。这些差异可能源于遗传和非遗传（环境、社会经济人口统计学、文化和行为）因素之间的相互作用。为了阐明这些因素对SLE预后的影响，我们建立了一个多民族（西班牙裔、非裔美国人和白种人）的美国早期队列（疾病持续时间<5年）。十年后，从LUMINA（少数族裔狼疮：先天与后天）队列中得出了有趣的数据。例如，来自德克萨斯州的非裔美国人和西班牙裔比来自波多黎各的白种人和西班牙裔病情更严重。缺乏私人保险、SLE急性发作、HLA - DRB101（DR1）和C4A3等位基因的表达与更高的疾病活动度相关，而年龄、符合美国风湿病学会标准的数量、疾病活动度、皮质类固醇的使用和异常疾病行为是损伤的一致预测因素。反过来，发现损伤和贫困可预测死亡率。我们现在计划应用新方法（基因混合）来解开影响SLE预后的遗传和非遗传因素之间的复杂相互作用。这些数据可能会对旨在消除美国健康差距的政策制定产生影响。
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