Parks C G, De Roos A J
1Epidemiology Branch, National Institute of Environmental Health Sciences, NC, USA.
Lupus. 2014 May;23(6):527-36. doi: 10.1177/0961203313511680.
Growing evidence suggests exposure to chemicals and industrial pollutants may increase risk of systemic lupus erythematosus (SLE). Here we review research on SLE associations with occupational and industrial exposures, primarily drawing on studies in human populations and summarizing epidemiologic research published in the past decade. The association of occupational silica exposure with SLE is well established, but key questions remain, including the required dose and susceptibility factors, and SLE risk due to other silicate exposures. Research on SLE and other exposures is less well developed, though several potential associations merit further consideration because of the consistency of preliminary human findings, experimental animal research, and biologic plausibility. These include pesticides and solvents, for which experimental findings also support investigation of specific agents, including organochlorines and trichloroethylene. Experimental findings and biologic plausibility suggest research on SLE and occupational exposure to hydrocarbons (i.e. mineral oils) is warranted, especially given the widespread exposures in the population. Experimental and limited human findings support further investigation of SLE related to mercury exposure, especially in dental occupations. Research on environmental risk factors in risk-enriched cohorts (family-based) is recommended, as is further investigation of exposures in relation to intermediate markers of effect (e.g. antinuclear antibodies), clinical features (e.g. nephritis), and outcomes.
越来越多的证据表明，接触化学物质和工业污染物可能会增加系统性红斑狼疮（SLE）的风险。在此，我们回顾了关于SLE与职业和工业接触之间关联的研究，主要借鉴了人群研究，并总结了过去十年发表的流行病学研究。职业性接触二氧化硅与SLE之间的关联已得到充分证实，但关键问题仍然存在，包括所需剂量和易感因素，以及其他硅酸盐接触导致的SLE风险。关于SLE与其他接触的研究发展较少，不过由于初步人体研究结果、实验动物研究和生物学合理性的一致性，有几个潜在关联值得进一步考虑。这些包括农药和溶剂，其实验结果也支持对特定制剂进行调查，包括有机氯和三氯乙烯。实验结果和生物学合理性表明，有必要对SLE与职业性接触碳氢化合物（即矿物油）进行研究，特别是考虑到人群中广泛的接触情况。实验和有限的人体研究结果支持进一步调查与汞接触相关的SLE，特别是在牙科职业中。建议在风险富集队列（基于家庭）中研究环境风险因素，同时进一步调查与效应中间标志物（如抗核抗体）、临床特征（如肾炎）和结局相关的接触情况。
