Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec. 3, Chung Yang Rd, Hualien, 970, Taiwan.
Management Office for Health Data, China Medical University Hospital, and College of Medicine, China Medical University, Taichung, Taiwan.
Arch Gynecol Obstet. 2020 Nov;302(5):1197-1203. doi: 10.1007/s00404-020-05726-9. Epub 2020 Aug 6.
The etiology of endometriosis is mostly under-explored, but abnormalities in the immune system leading to an autoimmune reaction have been suggested. The systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases. The purpose of this study was to investigate the risk of SLE in patients with endometriosis.
A total of 17,779 patients with endometriosis and 17,779 controls (without endometriosis) matched by age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 2000 and 2012. Patients were then followed until the end of 2013 using Taiwan's National Health Insurance Research Database, at which time participants who developed SLE were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with a 95% confidence interval (CI) of SLE incidence rate between patients with endometriosis and unaffected controls.
After adjusting for age, CCI score, and different treatment options, patients with endometriosis were at increased risk of SLE compared to unaffected controls (0.85 versus 0.57 per 1000 person-years, HR 1.86, 95% CI 1.36-2.53). Also, higher baseline CCI scores (CCI score 1-2 and ≥ 3 vs. 0-HR 2.33-4.98) were at increased risk of SLE. During follow-up, hormonal treatment for endometriosis could reduce the risk of SLE (short-term and long-term vs. non-use HR 0.48-0.62), while surgical treatment appeared to have a limited impact on the risk of SLE.
Patients with endometriosis were at increased risk of SLE, and adequate hormonal treatment could reduce the risk of SLE, providing a reference for developing prevention interventions.
子宫内膜异位症的病因大多尚未得到充分研究，但免疫系统异常导致自身免疫反应的情况已被提出。系统性红斑狼疮（SLE）是最常见的自身免疫性疾病之一。本研究旨在探讨子宫内膜异位症患者患 SLE 的风险。
本研究共纳入了 17779 名子宫内膜异位症患者和 17779 名年龄、索引年份和 Charlson 合并症指数（CCI）评分相匹配的对照组（无子宫内膜异位症）。2000 年至 2012 年期间，通过台湾全民健康保险研究数据库对患者进行了随访，直至 2013 年底，在此期间确定了患有 SLE 的参与者。采用 Cox 回归分析计算了子宫内膜异位症患者与无影响对照组 SLE 发病率的风险比（HR）及其 95%置信区间（CI）。
调整年龄、CCI 评分和不同治疗方案后，与无影响对照组相比，子宫内膜异位症患者患 SLE 的风险增加（0.85 比 0.57/1000 人年，HR 1.86，95%CI 1.36-2.53）。此外，基线 CCI 评分较高（CCI 评分 1-2 和≥3 比 0-HR 2.33-4.98）的患者患 SLE 的风险增加。在随访期间，子宫内膜异位症的激素治疗可以降低 SLE 的风险（短期和长期与非使用 HR 0.48-0.62），而手术治疗似乎对 SLE 的风险影响有限。
子宫内膜异位症患者患 SLE 的风险增加，充分的激素治疗可以降低 SLE 的风险，为制定预防干预措施提供参考。
