Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, and Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.
Arthritis Rheumatol. 2015 May;67(5):1369-76. doi: 10.1002/art.39059.
To test the a priori hypothesis that acute and chronic work exposures to the World Trade Center (WTC) site on or after September 11, 2001 were associated with risk of new-onset systemic autoimmune diseases.
A nested case-control study was performed in WTC rescue/recovery workers who had received a rheumatologist-confirmed systemic autoimmune disease diagnosis between September 12, 2001 and September 11, 2013 (n = 59), each of whom was individually matched to 4 randomly selected controls (n = 236) on the basis of year of hire (±1 year), sex, race, and work assignment (firefighter or emergency medical service). Acute exposure was defined according to the earliest time of arrival (morning of 9/11 versus later) at the WTC site, and chronic exposure was defined as duration (number of months) of WTC site-related work. Rheumatologists were blinded with regard to each subject's exposure status. The conditional odds ratios (CORs) with 95% confidence intervals (95% CIs) for incident autoimmune disease were derived from exact conditional logistic regression models.
Rheumatoid arthritis was the most common autoimmune diagnosis (37% of subjects), followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus erythematosus (12%), systemic sclerosis (5%), Sjögren's syndrome (5%), antiphospholipid syndrome (3%), and granulomatosis with polyangiitis (Wegener's) (2%). The COR for incident autoimmune disease increased by 13% (COR 1.13, 95% CI 1.02-1.26) for each additional month worked at the WTC site. These odds were independent of the association between high acute exposure (working during the morning of 9/11) and disease outcome, which conveyed an elevated, but not statistically significant, risk (COR 1.85, 95% CI 0.86-3.89).
Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The WTC Health Program should expand surveillance efforts for those with extended exposures, as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life.
检验下述先验假设，即 2001 年 9 月 11 日后在世界贸易中心（WTC）现场进行的急性和慢性工作暴露与新发系统性自身免疫性疾病的风险相关。
对 2001 年 9 月 12 日至 2013 年 9 月 11 日期间接受风湿病学家确诊的系统性自身免疫性疾病诊断的 WTC 救援/恢复工作者进行了一项巢式病例对照研究（n=59），每位患者均根据入职年份（±1 年）、性别、种族和工作分配（消防员或紧急医疗服务）与 4 名随机选择的对照（n=236）进行个体匹配。急性暴露根据最早到达 WTC 现场的时间（9 月 11 日上午与之后）定义，慢性暴露根据与 WTC 现场相关的工作时间（月数）定义。风湿病学家对每个研究对象的暴露情况不知情。使用精确条件逻辑回归模型得出新发自身免疫性疾病的条件比值比（COR）及其 95%置信区间（95%CI）。
类风湿关节炎是最常见的自身免疫性诊断（37%的患者），其次是脊柱关节炎（22%）、炎性肌病（14%）、系统性红斑狼疮（12%）、系统性硬化症（5%）、干燥综合征（5%）、抗磷脂综合征（3%）和肉芽肿性多血管炎（韦格纳氏）（2%）。在 WTC 现场工作的时间每增加一个月，新发自身免疫性疾病的 COR 增加 13%（COR 1.13，95%CI 1.02-1.26）。这些比值独立于与疾病结局相关的高急性暴露（在 9 月 11 日上午工作），这提示了一个升高但无统计学意义的风险（COR 1.85，95%CI 0.86-3.89）。
在 WTC 现场工作时间延长，而不考虑急性暴露，是与 9/11 后发生系统性自身免疫性疾病的重要预测因素。WTC 健康计划应扩大对暴露时间延长者的监测工作，因为早期发现可以促进早期治疗，这已被证明可以最小化器官损伤并提高生活质量。
