美国西班牙裔狼疮患者及其拉丁美洲混血儿对应人群的疾病特征与转归：一篇评论
Disease features and outcomes in United States lupus patients of Hispanic origin and their Mestizo counterparts in Latin America: a commentary.
作者信息
Ugarte-Gil Manuel F, Pons-Estel Guillermo J, Molineros Julio, Wojdyla Daniel, McGwin Gerald, Nath Swapan K, Pons-Estel Bernardo A, Alarcón-Riquelme Marta, Alarcón Graciela S
机构信息
Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Universidad Científica del Sur, Lima, Perú,
Department of Autoimmune Diseases, Institut Clinic de Medicina I Dermatologia, Hospital Clinic, Barcelona, Catalonia, Spain.
出版信息
Rheumatology (Oxford). 2016 Mar;55(3):436-40. doi: 10.1093/rheumatology/kev280. Epub 2015 Sep 27.
OBJECTIVE
To evaluate disease features and outcomes in two populations with significant Amerindian ancestry.
METHODS
Hispanic patients (from Texas) from the Lupus in Minorities: Nature versus Nurture (LUMINA) cohort and Mestizo patients from the Grupo Latino Americano De Estudio del Lupus or Latin American Group for the Study of Lupus (GLADEL) cohort were included. Disease features and outcomes were evaluated at baseline and last visit. Admixture informative markers of Mestizo Genoma de Lupus Eritematoso Sistémico Network consortium (GENLES) patients and Hispanic LUMINA patients were compared. Univariable analyses were performed using Chi square or Student's t test as appropriate. Multivariable analyses adjusting for possible confounders were carried out using Poisson, logistic or Cox regression models as appropriate.
RESULTS
A total of 114 LUMINA and 619 GLADEL patients were included. GLADEL patients had accrued more damage at baseline, but the opposite was the case at last visit. Being from LUMINA was a risk factor for damage accrual, even after adjusting for possible confounders [relative risk (RR) 1.33, 95% CI 1.12, 1.58]. Also, LUMINA patients have a higher risk of mortality than GLADEL patients [hazard ratio (HR) 2.37, 95% CI 1.10, 5.15], having 5-year survival of 85.6% and 94.5%, respectively. In addition, 79 LUMINA patients and 744 Mestizo GENLES patients were evaluated in order to compare genetic ancestry between the two groups; GENLES patients had a higher proportion of European ancestry (48.5% vs 43.3%, P = 0.003) and a lower proportion of Asian ancestry (3.7% vs 4.9%, P = 0.048), but the proportions of Amerindian and African ancestry were comparable in both.
CONCLUSION
USA Hispanic patients seemed to have a poorer prognosis than their counterparts from Latin America, despite having a comparable genetic background. Socioeconomic factors may account for these observations.
目的
评估两个具有显著美洲印第安人血统人群的疾病特征和预后情况。
方法
纳入来自“少数族裔狼疮：先天与后天”（LUMINA）队列研究中的西班牙裔患者（来自德克萨斯州）以及来自拉丁美洲狼疮研究组（GLADEL）队列研究中的混血患者。在基线期和末次随访时评估疾病特征和预后情况。比较了混血系统性红斑狼疮基因组网络联盟（GENLES）患者和西班牙裔LUMINA患者的混合信息性标记。根据情况使用卡方检验或学生t检验进行单变量分析。根据情况使用泊松回归、逻辑回归或Cox回归模型对可能的混杂因素进行调整后进行多变量分析。
结果
共纳入114例LUMINA患者和619例GLADEL患者。GLADEL患者在基线期累积的损伤更多，但在末次随访时情况相反。即使在对可能的混杂因素进行调整后，来自LUMINA队列仍是损伤累积的一个危险因素[相对风险（RR）1.33，95%置信区间（CI）1.12，1.58]。此外，LUMINA患者的死亡风险高于GLADEL患者[风险比（HR）2.37，95%CI 1.10，5.15]，5年生存率分别为85.6%和94.5%。此外，为比较两组之间的遗传血统，对79例LUMINA患者和744例混血GENLES患者进行了评估；GENLES患者的欧洲血统比例较高（48.5%对43.3%，P = 0.003），亚洲血统比例较低（3.7%对4.9%，P = 0.048），但美洲印第安人和非洲血统的比例在两者中相当。
结论
美国西班牙裔患者尽管具有相似的遗传背景，但其预后似乎比来自拉丁美洲的患者更差。社会经济因素可能解释了这些观察结果。
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