Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Show Chwan Memorial Hospital, Changhua, Taiwan.
J Dermatol. 2019 Jan;46(1):26-32. doi: 10.1111/1346-8138.14683. Epub 2018 Oct 27.
Chronic urticaria (CU) may be closely pathogenically related to systemic lupus erythematosus (SLE). This study aims to investigate the association between CU and SLE patients in Taiwan. A nationwide population-based cohort study from 1997 to 2013 was conducted. Investigated subjects were selected from the Taiwan National Health Insurance Research Database using the International Classification of Disease, Ninth Revision code. Participants consisted of 13 845 subjects newly diagnosed with CU from 2003 to 2013. We estimated the incidence risk of SLE among patients with CU by time-to-event analysis. Patients with CU were more likely to be female, and had a significant difference in urbanization and length of hospital stays (P < 0.0001). The incidence rates of SLE for the CU and control groups were 3.55 and 1.68, respectively. The crude hazard ratio of SLE among subjects with CU was 2.113 compared with the non-urticarial control group. After adjusting the demographic, length of hospital stay and comorbidity, the adjusted hazard ratio (aHR) of SLE was still significantly higher in the CU group (aHR = 2.113) compared with the control group. The use of non-steroidal anti-inflammatory drugs or corticosteroids may decrease the risk of SLE in patients with CU (P = 0.0216 and 0.0120, respectively). In conclusion, CU is associated with a higher risk of incidental SLE in this population-based, nationwide, cohort study. Inflammation and immune dysregulation are considered two potential mechanisms. Clinically, patients with urticaria should be carefully evaluated for risk of future SLE.
慢性荨麻疹（CU）可能与系统性红斑狼疮（SLE）在发病机制上密切相关。本研究旨在探讨台湾 CU 与 SLE 患者之间的关联。本研究采用了 1997 年至 2013 年的全国性基于人群的队列研究。研究对象是从台湾全民健康保险研究数据库中通过国际疾病分类，第九版代码选择的。参与者包括 2003 年至 2013 年期间首次被诊断为 CU 的 13845 名患者。我们通过时间事件分析来评估 CU 患者发生 SLE 的风险。患有 CU 的患者更可能为女性，并且在城市化程度和住院时间方面存在显著差异（P<0.0001）。CU 和对照组的 SLE 发生率分别为 3.55 和 1.68。与非荨麻疹对照组相比，CU 患者中 SLE 的粗风险比为 2.113。在调整人口统计学、住院时间和合并症后，CU 组的调整后的风险比（aHR）仍然显著高于对照组（aHR=2.113）。与 CU 组相比，使用非甾体抗炎药或皮质类固醇可能会降低 CU 患者发生 SLE 的风险（P=0.0216 和 0.0120）。总之，在这项基于人群的全国性队列研究中，CU 与 SLE 发生的风险增加有关。炎症和免疫失调被认为是两种潜在的机制。临床上，应仔细评估患有荨麻疹的患者未来发生 SLE 的风险。
