与青少年特发性关节炎相关的风险因素：从妊娠到疾病诊断期间接触香烟烟雾和空气污染。

Risk Factors Associated with Juvenile Idiopathic Arthritis: Exposure to Cigarette Smoke and Air Pollution from Pregnancy to Disease Diagnosis.

机构信息

From the Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, and the Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, and Emergency Department, Children's Institute, Faculdade de Medicina, Universidade de São Paulo, São Paulo; Environmental Exposure and Risk Assessment Group, Collective Health Post-graduation Program, Universidade Católica de Santos, Santos, Brazil.

C.M. França, MD, PhD, Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina, Universidade de São Paulo; A.M. Sallum, MD, PhD, Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina, Universidade de São Paulo; A.L. Braga, MD, PhD, Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Faculdade de Medicina da Universidade de São Paulo, and Environmental Exposure and Risk Assessment Group, Collective Health Post-graduation Program, Universidade Católica de Santos; F.L. Strufaldi, MB, Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Faculdade de Medicina da Universidade de São Paulo; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina, Universidade de São Paulo, and Division of Rheumatology, Faculdade de Medicina, Universidade de São Paulo; S.C. Farhat, MD, PhD, Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Faculdade de Medicina da Universidade de São Paulo, and Emergency Department, Children's Institute, Faculdade de Medicina, Universidade de São Paulo.

出版信息

J Rheumatol. 2018 Feb;45(2):248-256. doi: 10.3899/jrheum.161500. Epub 2017 Nov 15.

DOI:10.3899/jrheum.161500

PMID:29142039

Abstract

OBJECTIVE

To evaluate exposure to environmental factors inhaled during pregnancy and after birth until juvenile idiopathic arthritis (JIA) diagnosis among residents of a large city.

METHODS

This is an exploratory case-control study that consists of 66 patients with JIA and 124 healthy controls matched by age and sex, living in the São Paulo, Brazil, metropolitan area until JIA diagnosis, and whose mothers had resided in this region during pregnancy. A structured and reliable questionnaire (κ index for test-retest was 0.80) assessed demographic data, gestational and perinatal-related factors, and exposure to inhalable environmental elements during pregnancy and after birth (occupational exposure to inhalable particles and/or volatile vapor, exposure to cigarette smoke, and the presence of industrial activities or gas stations near the home, work, daycare, or school). Tropospheric pollutants included particulate matter (PM), sulfur dioxide (SO), nitrogen dioxide (NO), ozone (O), and carbon monoxide (CO).

RESULTS

During pregnancy, intrauterine cigarette smoke exposure (OR 3.43, 95% CI 1.45-8.12, p = 0.005) and maternal occupational exposure (OR 13.69, 95% CI 4.4-42.3, p < 0.001) were significant independent risk factors for JIA diagnosis. In contrast, maternal employment (OR 0.06, 95% CI 0.02-0.2, p < 0.001) and ideal maternal weight gain (OR 0.36, 95% CI 0.2-0.8, p = 0.017) presented negative associations. Secondhand smoke exposure from birth to JIA diagnosis (OR 3.6, 95% CI 1.8-7.3, p < 0.001) and exposure to O during the second year of life (OR 2.76, 95% CI 1.20-6.37, p = 0.017) were independent and significant risk factors for the pathogenesis of JIA.

CONCLUSION

In our study, cigarette smoke exposure (intrauterine and after birth), exposure to O in the second year of life, and maternal occupational exposure were identified as potential risk factors for JIA, warranting further study.

摘要

目的

评估在妊娠和出生后至幼年特发性关节炎（JIA）诊断期间，居住在大城市的居民吸入的环境因素暴露情况。

方法

这是一项探索性病例对照研究，包括 66 名 JIA 患者和 124 名健康对照者，这些对照者按年龄和性别与 JIA 患者相匹配，居住在巴西圣保罗大都市区，直至 JIA 诊断，并在妊娠期间和出生后其母亲一直居住在该地区。采用结构化和可靠的问卷（测试-重测 κ 指数为 0.80）评估了人口统计学数据、妊娠和围产期相关因素以及妊娠和出生后吸入环境元素的暴露情况（职业性吸入颗粒物和/或挥发性蒸气暴露、接触香烟烟雾以及家庭、工作、日托或学校附近存在工业活动或加油站）。对流层污染物包括颗粒物（PM）、二氧化硫（SO）、二氧化氮（NO）、臭氧（O）和一氧化碳（CO）。

结果

妊娠期间，宫内香烟烟雾暴露（OR 3.43，95%CI 1.45-8.12，p = 0.005）和母亲职业性暴露（OR 13.69，95%CI 4.4-42.3，p < 0.001）是 JIA 诊断的显著独立危险因素。相反，母亲就业（OR 0.06，95%CI 0.02-0.2，p < 0.001）和理想的母亲体重增加（OR 0.36，95%CI 0.2-0.8，p = 0.017）呈现负相关。从出生到 JIA 诊断的二手烟暴露（OR 3.6，95%CI 1.8-7.3，p < 0.001）和生命第二年暴露于 O（OR 2.76，95%CI 1.20-6.37，p = 0.017）是 JIA 发病的独立且显著的危险因素。