Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colo.
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Allergy Clin Immunol. 2020 Feb;145(2):563-571.e8. doi: 10.1016/j.jaci.2019.09.015. Epub 2019 Nov 19.
Limited evidence suggests increased fracture risk in people with atopic eczema. Any link could have substantial effect; atopic eczema is common, and fractures have associated morbidity and mortality.
We sought to examine whether atopic eczema is associated with fracture and whether fracture risk varies with eczema severity.
We performed a matched cohort study set in primary care (Clinical Practice Research Datalink GOLD 1998-2016) and linked hospital admissions data (Hospital Episode Statistics), including adults (≥18 years old) with atopic eczema matched (by age, sex, general practice, and cohort entry date) with up to 5 individuals without eczema. We estimated hazard ratios (HRs) from stratified Cox regression comparing risk of major osteoporotic (hip, pelvis, spine, wrist, and proximal humerus) fractures individually and any fracture in those with and without atopic eczema.
We identified 526,808 people with atopic eczema and 2,569,030 people without atopic eczema. Those with eczema had increased risk of hip (HR, 1.10; 99% CI, 1.06-1.14), pelvic (HR, 1.10; 99% CI, 1.02-1.19), spinal (HR, 1.18; 99% CI, 1.10-1.27), and wrist (HR, 1.07; 99% CI, 1.03,-1.11) fractures. We found no evidence of increased proximal humeral (HR, 1.06; 99% CI, 0.97-1.15) fracture risk. Fracture risk increased with increasing eczema severity, with the strongest associations in people with severe eczema (compared with those without) for spinal (HR, 2.09; 99% CI, 1.66-2.65), pelvic (HR, 1.66; 99% CI, 1.26-2.20), and hip (HR, 1.50; 99% CI, 1.30-1.74) fractures. Associations persisted after oral glucocorticoid adjustment.
People with atopic eczema have increased fracture risk, particularly major osteoporotic fractures.
有限的证据表明特应性皮炎患者骨折风险增加。任何关联都可能产生重大影响；特应性皮炎很常见，而骨折会带来相关的发病率和死亡率。
我们旨在研究特应性皮炎是否与骨折相关，以及骨折风险是否随湿疹严重程度而变化。
我们开展了一项匹配队列研究，该研究在初级保健机构（临床实践研究数据链接 GOLD 1998-2016）中进行，并链接了住院患者数据（医院入院统计），包括年龄在 18 岁及以上的特应性皮炎患者（按年龄、性别、全科医生和队列入组日期与多达 5 名无特应性皮炎的患者相匹配）。我们通过分层 Cox 回归分析，比较了特应性皮炎患者和无特应性皮炎患者的主要骨质疏松性（髋部、骨盆、脊柱、腕部和肱骨近端）骨折风险，以及特应性皮炎患者和无特应性皮炎患者的所有骨折风险。
我们确定了 526808 名特应性皮炎患者和 2569030 名无特应性皮炎患者。患有湿疹的患者发生髋部（HR，1.10；99%CI，1.06-1.14）、骨盆（HR，1.10；99%CI，1.02-1.19）、脊柱（HR，1.18；99%CI，1.10-1.27）和腕部（HR，1.07；99%CI，1.03-1.11）骨折的风险增加。我们未发现肱骨近端（HR，1.06；99%CI，0.97-1.15）骨折风险增加的证据。随着湿疹严重程度的增加，骨折风险也随之增加，在严重湿疹患者中（与无湿疹患者相比），脊柱（HR，2.09；99%CI，1.66-2.65）、骨盆（HR，1.66；99%CI，1.26-2.20）和髋部（HR，1.50；99%CI，1.30-1.74）骨折的相关性最强。在口服糖皮质激素调整后，相关性仍然存在。
特应性皮炎患者骨折风险增加，尤其是发生主要骨质疏松性骨折。
