Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0429, USA.
J Autoimmun. 2012 May;38(2-3):J97-J102. doi: 10.1016/j.jaut.2011.08.001. Epub 2011 Aug 30.
Infection has long been implicated as a trigger for autoimmune disease. Other antigenic challenges include receipt of allogeneic tissue or blood resulting in immunomodulation. We investigated antigenic challenges as possible risk factors for autoimmune disease in women using the Health and Retirement Study, a nationally representative longitudinal study, linked to Medicare files, years 1991-2007. The prevalence of autoimmune disease (rheumatoid arthritis, Hashimoto's disease, Graves' disease, systemic lupus erythematosus, celiac disease, systemic sclerosis, Sjögren syndrome and multiple sclerosis) was 1.4% in older women (95% CI: 1.3%, 1.5%) with significant variation across regions of the United States. The risk of autoimmune disease increased by 41% (95% CI of incidence rate ratio (IRR): 1.10, 1.81) with a prior infection-related medical visit. The risk of autoimmune disease increased by 90% (95% CI of IRR: 1.36, 2.66) with a prior transfusion without infection. Parity was not associated with autoimmune disease. Women less than 65 years of age and Jewish women had significantly elevated risk of developing autoimmune disease, as did individuals with a history of heart disease or end-stage renal disease. Antigenic challenges, such as infection and allogeneic blood transfusion, are significant risk factors for the development of autoimmune disease in older women.
感染长期以来一直被认为是自身免疫性疾病的诱因。其他抗原性挑战包括接受同种异体组织或血液，导致免疫调节。我们使用健康与退休研究（一项具有全国代表性的纵向研究），结合医疗保险档案，调查了 1991-2007 年期间女性的抗原性挑战是否为自身免疫性疾病的风险因素。自身免疫性疾病（类风湿关节炎、桥本甲状腺炎、格雷夫斯病、系统性红斑狼疮、乳糜泻、系统性硬皮病、干燥综合征和多发性硬化症）的患病率在老年女性中为 1.4%（95%CI：1.3%，1.5%），在美国各地区之间存在显著差异。先前与感染相关的就诊会使自身免疫性疾病的风险增加 41%（95%CI 的发病率比（IRR）：1.10，1.81）。先前没有感染的输血会使自身免疫性疾病的风险增加 90%（95%CI 的 IRR：1.36，2.66）。生育次数与自身免疫性疾病无关。年龄小于 65 岁的女性和犹太女性发生自身免疫性疾病的风险显著增加，有心脏病或终末期肾病病史的个体也是如此。抗原性挑战，如感染和同种异体输血，是老年女性发生自身免疫性疾病的重要危险因素。
