Brown Linda Morris, Gridley Gloria, Check David, Landgren Ola
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Blood. 2008 Apr 1;111(7):3388-94. doi: 10.1182/blood-2007-10-121285. Epub 2008 Jan 31.
In a retrospective cohort of more than 4 million white and black male United States (US) veterans, we explored the role of specific prior autoimmune, infectious, inflammatory, and allergic disorders in the etiology of multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS). Patients were selected from computerized inpatient discharge records at US Veterans Affairs hospitals. The analysis included 4641 patients (3040 white, 1601 black) and 2046 patients (1312 white; 734 black) with a discharge diagnosis of MM and MGUS, respectively. Using Poisson regression, we calculated age-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relationship between MM, MGUS, and specific prior medical conditions. Significantly elevated risks of MM were associated with broad categories of autoimmune (RR, 1.15; 95% CI, 1.02-1.28), infectious (RR, 1.29; 95% CI, 1.20-1.38), and inflammatory disorders (RR, 1.18; 95% CI, 1.10-1.27) and specific prior autoimmune (polymyositis/dermatomyositis, systemic sclerosis, autoimmune hemolytic anemia, pernicious anemia, and ankylosing spondylitis), infectious (pneumonia, hepatitis, meningitis, septicemia, herpes zoster, and poliomyelitis), and inflammatory (glomerulonephritis, nephrotic syndrome, and osteoarthritis) disorders. Risks for MGUS were generally of similar magnitude. Our results indicate that various types of immune-mediated conditions might act as triggers for MM/MGUS development.
在一项超过400万美国白人和黑人男性退伍军人的回顾性队列研究中，我们探讨了特定的既往自身免疫性、感染性、炎症性和过敏性疾病在多发性骨髓瘤（MM）和意义未明的单克隆丙种球蛋白病（MGUS）病因中的作用。患者选自美国退伍军人事务部医院的计算机化住院出院记录。分析包括分别有出院诊断为MM和MGUS的4641例患者（3040例白人，1601例黑人）和2046例患者（1312例白人；734例黑人）。使用泊松回归，我们计算了MM、MGUS与特定既往疾病之间关系的年龄调整相对风险（RRs）和95%置信区间（CIs）。MM风险显著升高与广泛的自身免疫性疾病（RR，1.15；95%CI，1.02 - 1.28）、感染性疾病（RR，1.29；95%CI，1.20 - 1.38）和炎症性疾病（RR，1.18；95%CI，1.10 - 1.27）以及特定的既往自身免疫性疾病（多发性肌炎/皮肌炎、系统性硬化症、自身免疫性溶血性贫血、恶性贫血和强直性脊柱炎）、感染性疾病（肺炎、肝炎、脑膜炎、败血症、带状疱疹和脊髓灰质炎）和炎症性疾病（肾小球肾炎、肾病综合征和骨关节炎）有关。MGUS的风险通常幅度相似。我们的结果表明，各种类型的免疫介导疾病可能是MM/MGUS发生的触发因素。
