Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland.
John Stearne Medical Library, School of Medicine, Trinity College Dublin, Ireland.
Autoimmun Rev. 2020 Nov;19(11):102660. doi: 10.1016/j.autrev.2020.102660. Epub 2020 Sep 15.
Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is a rare multi-system autoimmune disease, characterised by a pauci-immune necrotising small-vessel vasculitis, with a relapsing and remitting course. Like many autoimmune diseases, the exact aetiology of AAV, and the factors that influence relapse are unknown. Evidence suggests a complex interaction of polygenic genetic susceptibility, epigenetic influences and environmental triggers. This systematic mapping review focuses on the environmental risk factors associated with AAV. The aim was to identify gaps in the literature, thus informing further research.
Articles that examined any environmental risk factor in AAV disease activity (new onset disease or relapse) were included. Studies had to make explicit reference to AAV, which includes the 3 clinico-pathological phenotypes (GPA, MPA and EGPA), rather than isolated ANCA-positivity. All articles identified were English-language, full manuscripts involving adult humans (>16 years). There was no restriction on publication date and all study designs, except single case reports, were included. The systematic search was performed on 9th December 2019, using the following databases: EMBASE, Medline (Ovid), Cochrane Library, CINAHL and Web of Science.
The search yielded a total of 2375 articles. 307 duplicates were removed, resulting in the title and abstract of 2068 articles for screening. Of these, 1809 were excluded. Thus, 259 remained for full-text review, of which 181 were excluded. 78 articles were included in this review. The most notable findings support the role of various pollutants - primarily silica and other environmental antigens released during natural disasters and through farming. Assorted geoepidemiological triggers were also identified including seasonality and latitude-dependent factors such as UV radiation. Finally, infection was tightly associated, but the exact microorganism(s) is not clear - Staphylococcus aureus is the most presently convincing.
The precise aetiology of AAV has yet to be elucidated. It is likely that different triggers, and the degree to which they influence disease activity, vary by subgroup (e.g. ANCA subtype, geographic region). There is a need for more interoperable disease registries to facilitate international collaboration and hence large-scale epidemiological studies, with novel analytical techniques.
抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）是一种罕见的多系统自身免疫性疾病，其特征为少免疫性坏死性小血管血管炎，具有复发性和缓解性病程。与许多自身免疫性疾病一样，AAV 的确切病因以及影响复发的因素尚不清楚。有证据表明，多基因遗传易感性、表观遗传影响和环境触发因素之间存在复杂的相互作用。本系统映射综述重点关注与 AAV 相关的环境危险因素。目的是确定文献中的空白，从而为进一步的研究提供信息。
纳入了研究 AAV 疾病活动（新发疾病或复发）相关的任何环境危险因素的文章。研究必须明确提及 AAV，包括 3 种临床病理表型（GPA、MPA 和 EGPA），而不仅仅是孤立的 ANCA 阳性。所有确定的文章均为英文全文，涉及成人（>16 岁）。没有对发表日期的限制，除了单病例报告外，所有研究设计均包括在内。系统检索于 2019 年 12 月 9 日在以下数据库中进行：EMBASE、Medline（Ovid）、Cochrane 图书馆、CINAHL 和 Web of Science。
搜索共产生了 2375 篇文章。剔除 307 篇重复文章后，对 2068 篇文章进行了标题和摘要筛选。其中 1809 篇被排除。因此，259 篇文章进行了全文审查，其中 181 篇被排除。78 篇文章被纳入本综述。最值得注意的发现支持了各种污染物的作用-主要是二氧化硅和自然灾害以及农业生产过程中释放的其他环境抗原。还确定了各种地理流行病学触发因素，包括季节性和与纬度相关的因素，如紫外线辐射。最后，感染与疾病活动密切相关，但确切的微生物尚不清楚-金黄色葡萄球菌是目前最有说服力的。
AAV 的确切病因尚未阐明。不同的诱因及其对疾病活动的影响程度可能因亚组（例如 ANCA 亚型、地理位置）而异。需要更多可互操作的疾病登记处，以促进国际合作，并进行具有创新性分析技术的大规模流行病学研究。
