Dalin Frida, Nordling Eriksson Gabriel, Dahlqvist Per, Hallgren Åsa, Wahlberg Jeanette, Ekwall Olov, Söderberg Stefan, Rönnelid Johan, Olcén Per, Winqvist Ola, Catrina Sergiu-Bogdan, Kriström Berit, Laudius Maria, Isaksson Magnus, Halldin Stenlid Maria, Gustafsson Jan, Gebre-Medhin Gennet, Björnsdottir Sigridur, Janson Annika, Åkerman Anna-Karin, Åman Jan, Duchen Karel, Bergthorsdottir Ragnhildur, Johannsson Gudmundur, Lindskog Emma, Landin-Olsson Mona, Elfving Maria, Waldenström Erik, Hulting Anna-Lena, Kämpe Olle, Bensing Sophie
Centre for Molecular Medicine, Department of Medicine (Solna).
Science for Life Laboratory, Department of Medical Sciences, and.
J Clin Endocrinol Metab. 2017 Feb 1;102(2):379-389. doi: 10.1210/jc.2016-2522.
Studies of the clinical and immunological features of autoimmune Addison disease (AAD) are needed to understand the disease burden and increased mortality.
To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles, and cardiovascular risk factors.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, population-based study that included 660 AAD patients from the Swedish Addison Registry (2008-2014). When analyzing the cardiovascular risk factors, 3594 individuals from the population-based survey in Northern Sweden, MONICA (monitoring of trends and determinants of cardiovascular disease), served as controls.
The endpoints were the prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.
The proportion of 21-hydroxylase autoantibody-positive patients was 83%, and 62% of patients had ≥1 associated autoimmune diseases, more frequently coexisting in females (P < 0.0001). AAD patients had a lower body mass index (P < 0.0001) and prevalence of hypertension (P = 0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of the patients, with a mean dose of 28.1 ± 8.5 mg/d. The mean hydrocortisone equivalent dose normalized to the body surface was 14.8 ± 4.4 mg/m2/d. A greater hydrocortisone equivalent dose was associated with a greater incidence of hypertension (P = 0.046).
Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients did not have an increased prevalence of overweight, hypertension, type 2 diabetes mellitus, or hyperlipidemia. However, high glucocorticoid replacement doses could be a risk factor for hypertension.
需要对自身免疫性艾迪生病（AAD）的临床和免疫特征进行研究，以了解疾病负担和死亡率上升情况。
提供关于自身免疫性合并症、替代疗法、自身抗体谱和心血管危险因素的最新数据。
设计、地点和参与者：一项基于人群的横断面研究，纳入了瑞典艾迪生病登记处（2008 - 2014年）的660例AAD患者。在分析心血管危险因素时，来自瑞典北部基于人群的调查“MONICA（心血管疾病趋势和决定因素监测）”的3594人作为对照。
终点是自身免疫性合并症和心血管危险因素的患病率。测定了针对13种自身抗原的自身抗体。
21 - 羟化酶自身抗体阳性患者的比例为83%，62%的患者患有≥1种相关自身免疫性疾病，女性中更常见（P < 0.0001）。与对照组相比，AAD患者的体重指数较低（P < 0.0001），高血压患病率较低（P = 0.027）。89%的患者使用传统氢化可的松片，平均剂量为28.1±8.5mg/d。根据体表面积标准化的平均氢化可的松等效剂量为14.8±4.4mg/m²/d。更高的氢化可的松等效剂量与更高的高血压发病率相关（P = 0.046）。
有必要对AAD患者进行仔细监测，以发现相关的自身免疫性疾病。当代瑞典AAD患者超重、高血压、2型糖尿病或高脂血症的患病率并未增加。然而，高剂量糖皮质激素替代可能是高血压的一个危险因素。
