O'Hanlon Terrance, Koneru Bhanu, Bayat Elham, Love Lori, Targoff Ira, Malley James, Malley Karen, Miller Frederick
Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, NIH, 9 Memorial Drive, Bethesda, MD 10892, USA.
Arthritis Rheum. 2004 Nov;50(11):3646-50. doi: 10.1002/art.20587.
To determine whether patients in whom myositis develops after they receive silicone breast implants have distinct clinical, serologic, and/or immunogenetic features compared with patients with myositis who do not have silicone implants.
A preliminary case series study was followed by a larger, independent, matched case-control study to evaluate women in whom myositis developed after they received silicone implants (MASI patients) compared with healthy women with silicone implants and women with myositis but without silicone implants (idiopathic inflammatory myopathy; IIM patients).
In a preliminary study, 11 MASI patients differed from 76 IIM patients in having an increased frequency of HLA-DQA10102 (odds ratio [OR] 9.8, 95% confidence interval [95% CI] 1.77-96.79) and decreased frequencies of the myositis-associated risk factor DRB10301 (OR 0.1 [95% CI 0.002-0.63]) and its linked allele DQA10501 (OR 0.2 [95% CI 0.02-0.87]). A subsequent independent, matched case-control study revealed that although clinical features and autoantibodies did not differ significantly between the MASI and IIM groups, MASI patients again had decreased frequencies of DRB10301 (OR 0.2 [95% CI 0.07-0.72]) and DQA10501 (OR 0.2 [95% CI 0.08-0.84]) compared with IIM patients. Additional comparisons between MASI patients from both studies combined (n = 37) and a larger population of IIM patients (n = 453) suggested that HLA-DQA10102 may be uniquely associated with MASI (OR 2.6 [95% CI 1.25-5.46]).
Women in whom inflammatory myopathy develops after they receive silicone implants constitute an immunogenetically distinct group of patients with myositis. These and other data suggest that autoimmune diseases as now defined may consist of multiple distinct entities, each of which is characterized by different genes and environmental exposures.
确定接受硅胶乳房植入物后发生肌炎的患者与未植入硅胶的肌炎患者相比，是否具有独特的临床、血清学和/或免疫遗传学特征。
在一项初步病例系列研究之后，开展了一项更大规模的、独立的、匹配病例对照研究，以评估接受硅胶植入物后发生肌炎的女性（硅胶植入后肌炎患者），并与植入硅胶的健康女性以及患有肌炎但未植入硅胶的女性（特发性炎性肌病患者）进行比较。
在初步研究中，11例硅胶植入后肌炎患者与76例特发性炎性肌病患者的差异在于，前者HLA-DQA10102的频率增加（优势比[OR]9.8，95%置信区间[95%CI]1.77-96.79），而肌炎相关危险因素DRB10301（OR 0.1[95%CI 0.002-0.63]）及其连锁等位基因DQA10501（OR 0.2[95%CI 0.02-0.87]）的频率降低。随后一项独立的、匹配病例对照研究显示，尽管硅胶植入后肌炎患者组和特发性炎性肌病患者组之间的临床特征和自身抗体无显著差异，但与特发性炎性肌病患者相比，硅胶植入后肌炎患者的DRB10301（OR 0.2[95%CI 0.07-0.72]）和DQA10501（OR 0.2[95%CI 0.08-0.84]）频率再次降低。将两项研究中的硅胶植入后肌炎患者（n = 37）与更多的特发性炎性肌病患者（n = 453）进行进一步比较，结果表明HLA-DQA10102可能与硅胶植入后肌炎具有独特的相关性（OR 2.6[95%CI 1.25-5.46]）。
接受硅胶植入物后发生炎性肌病的女性构成了一个免疫遗传学上独特的肌炎患者群体。这些以及其他数据表明，目前定义的自身免疫性疾病可能由多个不同的实体组成，每个实体都具有不同的基因和环境暴露特征。
