From Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Rheumatology, Division of Rheumatology, Allergy and Immunology, Harvard Medical School, Boston, Massachusetts, USA.
J.A. Aviña-Zubieta, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Research Scientist, Arthritis Research Canada; M. Jansz, MD, Internal Medicine Resident, Department of Medicine, Faculty of Medicine, University of British Columbia; E.C. Sayre, PhD, Statistician, Arthritis Research Canada; H.K. Choi, MD, DrPH, Professor of Medicine, Department of Rheumatology, Division of Rheumatology, Allergy and Immunology, Harvard Medical School, and Research Scientist, Arthritis Research Canada.
J Rheumatol. 2017 Aug;44(8):1184-1189. doi: 10.3899/jrheum.160185. Epub 2017 Mar 15.
To estimate the future risk and time trends of venous thromboembolism (VTE) in individuals with newly diagnosed primary Sjögren syndrome (pSS) in the general population.
Using a population database that includes all residents of British Columbia, Canada, we created a study cohort of all patients with incident SS and up to 10 controls from the general population matched for age, sex, and entry time. We compared incidence rates (IR) of pulmonary embolism (PE), deep vein thrombosis (DVT), and VTE between the 2 groups according to SS disease duration. We calculated HR, adjusting for confounders.
Among 1175 incident pSS cases (mean age 56.7 yrs, 87.6% women), the IR of PE, DVT, and VTE were 3.9, 2.8, and 5.2 per 1000 person-years (PY), respectively; the corresponding rates in the comparison cohort were 0.9, 0.8, and 1.4 per 1000 PY. Compared with non-SS individuals, the multivariable HR for PE, DVT, and VTE among SS cases were 4.07 (95% CI 2.04-8.09), 2.80 (95% CI 1.27-6.17), and 2.92 (95% CI 1.66-5.16), respectively. The HR matched for age, sex, and entry time for VTE, PE, and DVT were highest during the first year after SS diagnosis (8.29, 95% CI 2.57-26.77; 4.72, 95% CI 1.13-19.73; and 7.34, 95% CI 2.80-19.25, respectively).
These findings provide population-based evidence that patients with pSS have a substantially increased risk of VTE, especially within the first year after SS diagnosis. Further research into the involvement of monitoring and prevention of VTE in SS may be warranted.
估计新诊断原发性干燥综合征(pSS)个体中静脉血栓栓塞症(VTE)的未来风险和时间趋势。
利用包括加拿大不列颠哥伦比亚省所有居民的人群数据库,我们创建了一个包含所有 SS 患者的研究队列,以及最多 10 名与年龄、性别和入组时间相匹配的普通人群对照。根据 SS 病程比较两组之间肺栓塞(PE)、深静脉血栓形成(DVT)和 VTE 的发生率(IR)。我们调整了混杂因素后计算了 HR。
在 1175 例新发 pSS 病例中(平均年龄 56.7 岁,87.6%为女性),PE、DVT 和 VTE 的 IR 分别为 3.9、2.8 和 5.2/1000 人年(PY);对照组相应的比率分别为 0.9、0.8 和 1.4/1000 PY。与非 SS 个体相比,SS 病例中 PE、DVT 和 VTE 的多变量 HR 分别为 4.07(95%CI 2.04-8.09)、2.80(95%CI 1.27-6.17)和 2.92(95%CI 1.66-5.16)。与年龄、性别和入组时间匹配的 VTE、PE 和 DVT 的 HR 在 SS 诊断后第一年最高(8.29,95%CI 2.57-26.77;4.72,95%CI 1.13-19.73;7.34,95%CI 2.80-19.25)。
这些发现提供了基于人群的证据,表明 pSS 患者发生 VTE 的风险显著增加,尤其是在 SS 诊断后的第一年。可能需要进一步研究监测和预防 SS 中 VTE 的参与。