Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
BMJ Open. 2020 Dec 28;10(12):e041405. doi: 10.1136/bmjopen-2020-041405.
The aim of this study was to assess the association between air pollutant exposure and interstitial lung disease (ILD) in patients with connective tissue diseases (CTDs).
A nationwide, population-based, matched case-control study in Taiwan.
Using the 1997-2013 Taiwanese National Health Insurance Research Database, we identified patients with newly diagnosed CTD during 2001-2013, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), dermatomyositis (DMtis)/polymyositis (PM) and primary Sjögren's syndrome (pSS).
Patients with newly diagnosed ILD during 2012-2013 were identified as ILD cases, and selected patients with CTD without ILD matching (1:4) the CTD cases for CTD diagnosis, age, gender, disease duration and year of ILD diagnosis date were identified as non-ILD controls. Data of hourly level of air pollutants 1 year before the index date were obtained from the Taiwan Environmental Protection Agency. The association between ILD and air pollutant exposure was evaluated using logistic regression analysis shown as adjusted ORs (aORs) with 95% CIs after adjusting for potential confounders.
We identified 505 newly diagnosed CTD-ILD patients, including 82 with SLE, 210 with RA, 47 with SSc, 44 with DMtis/PM and 122 with pSS. Ozone (O) exposure (per 10 ppb) was associated with a decreased ILD risk in patients with CTD (aOR, 0.51; 95% CI, 0.33 to 0.79) after adjusting for potential confounders.
A previously unrecognised inverse correlation was found between O exposure and ILD in patients with RA and SSc. Further studies are warranted to explore the underlying mechanisms.
本研究旨在评估暴露于空气污染物与结缔组织疾病（CTD）患者间质性肺病（ILD）之间的关联。
在台湾进行的一项全国性、基于人群的匹配病例对照研究。
我们使用 1997-2013 年台湾全民健康保险研究数据库，确定了 2001-2013 年期间新诊断为 CTD 的患者，包括系统性红斑狼疮（SLE）、类风湿关节炎（RA）、系统性硬化症（SSc）、皮肌炎（DMtis）/多发性肌炎（PM）和原发性干燥综合征（pSS）。
2012-2013 年新诊断为ILD 的患者被确定为ILD病例，并选择无ILD的CTD患者（1:4）与CTD病例匹配，以确定CTD诊断、年龄、性别、疾病持续时间和ILD诊断日期的年份，作为非ILD对照。从台湾环境保护署获得了指数日期前 1 年每小时水平的空气污染物数据。使用逻辑回归分析评估ILD与空气污染物暴露之间的关系，结果表示为调整后的比值比（aOR），并在调整潜在混杂因素后给出 95%置信区间。
我们确定了 505 例新诊断的 CTD-ILD 患者，包括 82 例 SLE、210 例 RA、47 例 SSc、44 例 DMtis/PM 和 122 例 pSS。臭氧（O）暴露（每 10ppb）与 CTD 患者ILD风险降低相关（aOR，0.51；95%CI，0.33 至 0.79），在调整潜在混杂因素后。
在 RA 和 SSc 患者中，O 暴露与 ILD 之间存在以前未被认识到的负相关关系。需要进一步研究探索潜在的机制。
