免疫抑制剂对系统性红斑狼疮和原发性干燥综合征患者中非黑色素瘤皮肤癌的影响：台湾一项全国性回顾性病例对照研究。
The influence of immunosuppressants on the non-melanoma skin cancer among patients with systemic lupus erythematosus and primary Sjögren's syndrome: a nationwide retrospective case-control study in Taiwan.
机构信息
Department of Dermatology, Kaohsiung Veterans General Hospital, Taiwan; and Institute of Biomedical Sciences, National Sun Yat-Sen University, Taiwan.
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei; and Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.
出版信息
Clin Exp Rheumatol. 2019 Nov-Dec;37(6):946-952. Epub 2019 Apr 29.
OBJECTIVES
To investigate the influence of corticosteroids and hydroxychloroquine on the association with non-melanoma skin cancer (NMSC) among patients with systemic lupus erythematosus (SLE) or primary Sjögren's syndrome (pSS).
METHODS
This nationwide retrospective case-control study retrieved data from Taiwan National Health Insurance Research Database from 1995-2013. Cases with newly-diagnosed NMSC (n=19,603) and controls without NMSC were matched in a 1:1 ratio according to age, sex, and reference date. SLE, pSS, NMSC, and co-morbidities were determined by ICD-9-CM code. Cumulative drug exposures were defined by cumulative dosages or total defined daily dose (TDDD) of the Anatomical Therapeutic Chemical code of medicines. The analysis used conditional logistic regression and adjusted for age, sex, residential area, occupation, and co-morbidities. Case-control studies cannot infer the causality.
RESULTS
Compared to patients without SLE or pSS, the patients with SLE had significantly higher associations with NMSC (cases/controls: n=23/10, adjusted odds ratio (AOR)=2.33, 95% confidence interval (CI) 1.08-5.01), particularly those using corticosteroids with a cumulative dosage >5g (cases/controls: n=17/5, AOR=2.96, 95%CI 1.06-8.23); and those using hydroxychloroquine with a cumulative dosage >100 TDDD (cases/controls: n=18/6, AOR=2.7, 95%CI 1.04-6.98). The patients with pSS had significantly higher associations with NMSC (cases/controls: n=28/11, AOR=2.56, 95%CI 1.25-5.23), particularly those using hydroxychloroquine with a cumulative dosage >100TDDD (cases/controls: n=20/4, AOR=5.41, 95%CI 1.82-16.11), and those using corticosteroids with a cumulative dosage >1g (cases/controls: n=13/3, AOR=4.92, 95%CI 1.37-17.61).
CONCLUSIONS
The patients with SLE or pSS had significantly increased associations with NMSC, especially those receiving higher cumulative doses of corticosteroids and hydroxychloroquine.
目的
探讨皮质类固醇和羟氯喹对系统性红斑狼疮（SLE）或原发性干燥综合征（pSS）患者非黑色素瘤皮肤癌（NMSC）发病风险的影响。
方法
本项全国性回顾性病例对照研究从台湾全民健康保险研究数据库中检索了 1995 年至 2013 年的数据。按照年龄、性别和参考日期，将新诊断为 NMSC（n=19603）的病例与无 NMSC 的对照以 1:1 比例匹配。通过国际疾病分类第 9 版临床修正码（ICD-9-CM 码）确定 SLE、pSS、NMSC 和合并症。药物累积暴露量通过药物解剖治疗化学代码的累积剂量或总限定日剂量（TDDD）来定义。分析采用条件逻辑回归，并根据年龄、性别、居住地区、职业和合并症进行调整。病例对照研究不能推断因果关系。
结果
与无 SLE 或 pSS 的患者相比，SLE 患者 NMSC 的发病风险显著升高（病例/对照：n=23/10，调整后的比值比（AOR）=2.33，95%置信区间（CI）1.08-5.01），尤其是累积剂量>5g 的皮质类固醇（病例/对照：n=17/5，AOR=2.96，95%CI 1.06-8.23）；以及累积剂量>100TDDD 的羟氯喹（病例/对照：n=18/6，AOR=2.7，95%CI 1.04-6.98）。pSS 患者 NMSC 的发病风险也显著升高（病例/对照：n=28/11，AOR=2.56，95%CI 1.25-5.23），尤其是累积剂量>100TDDD 的羟氯喹（病例/对照：n=20/4，AOR=5.41，95%CI 1.82-16.11），以及累积剂量>1g 的皮质类固醇（病例/对照：n=13/3，AOR=4.92，95%CI 1.37-17.61）。
结论
SLE 或 pSS 患者的 NMSC 发病风险显著升高，尤其是接受较高累积剂量皮质类固醇和羟氯喹的患者。
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