Grulich Andrew E, Vajdic Claire M, Cozen Wendy
National Centre in HIV Epidemiology and Clinical Research, Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia.
Cancer Epidemiol Biomarkers Prev. 2007 Mar;16(3):405-8. doi: 10.1158/1055-9965.EPI-06-1070. Epub 2007 Mar 2.
This review examines the association between disorders of immunity, including immune deficiency, atopy, and autoimmune disease, and non-Hodgkin lymphoma (NHL). Immune deficiency is one of the strongest known risk factors for NHL. Risk is increased whether the immune deficiency is congenital, iatrogenic, or acquired. Risk of NHL increases with degree of immune deficiency, and there is no evidence of a threshold. In the profoundly immune deficient, NHL is frequently caused by infection with the ubiquitous EBV. Whether mild, subclinical immune deficiency is related to increased NHL risk is unknown. There is inconsistent evidence that atopic conditions, such as asthma, hayfever, and eczema, characterized by an immune response that is skewed toward Th2, are associated with a decreased risk of NHL. These data come mainly from case-control studies. Concern has been expressed that the association may be due to reverse causality if early symptoms of NHL include a lessening of atopic manifestations. Case-control and cohort studies of people with autoimmune conditions have generally shown that rheumatoid arthritis, systemic lupus erythematosis, and Sjogren's disease are associated with increased NHL risk. It seems to be the intensity of the inflammatory disease rather than its treatment which is related to increased risk of NHL. The study of altered immunity as a cause of NHL in case-control studies is limited by the fact that development of NHL in itself leads to altered immunity. Cohort studies of the role of altered immunity should be a top priority in epidemiologic studies of NHL etiology.
本综述探讨了包括免疫缺陷、特应性和自身免疫性疾病在内的免疫紊乱与非霍奇金淋巴瘤（NHL）之间的关联。免疫缺陷是已知最强的NHL风险因素之一。无论免疫缺陷是先天性、医源性还是后天获得性的，风险都会增加。NHL的风险随着免疫缺陷程度的增加而增加，且没有证据表明存在阈值。在严重免疫缺陷患者中，NHL常由普遍存在的EB病毒感染引起。轻度、亚临床免疫缺陷是否与NHL风险增加有关尚不清楚。有不一致的证据表明，以偏向Th2的免疫反应为特征的特应性疾病，如哮喘、花粉症和湿疹，与NHL风险降低有关。这些数据主要来自病例对照研究。有人担心，如果NHL的早期症状包括特应性表现减轻，这种关联可能是由于反向因果关系。对自身免疫性疾病患者的病例对照研究和队列研究总体上表明，类风湿性关节炎、系统性红斑狼疮和干燥综合征与NHL风险增加有关。似乎是炎症性疾病的强度而非其治疗与NHL风险增加有关。在病例对照研究中，将免疫改变作为NHL病因的研究受到NHL本身的发展会导致免疫改变这一事实的限制。在NHL病因的流行病学研究中，对免疫改变作用的队列研究应是首要任务。
