吸烟对系统性红斑狼疮累积损害的影响：一项队列研究。

The effect of smoking on cumulative damage in systemic lupus erythematosus: An incident cohort study.

机构信息

Department of Medicine, University of Wisconsin School of Medicine and Public Health (UW-SMPH), Madison, USA.

William S. Middleton Memorial Veterans Hospital, Madison, USA.

出版信息

Lupus. 2021 Apr;30(4):620-629. doi: 10.1177/0961203320988603. Epub 2021 Jan 20.

DOI:10.1177/0961203320988603

PMID:33470148

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7969411/

Abstract

OBJECTIVES

To investigate the relationship between smoking history and pack-year exposure on the rate of end-organ damage in systemic lupus erythematosus (SLE).

METHODS

The SLE incident cohort included patients who met American College of Rheumatology (ACR) 1997 or SLE International Collaborating Clinics (SLICC) 2012 SLE criteria and had rheumatology encounters at a US academic institution (2008-16). The primary outcome was median time to SLICC/ACR damage index (SLICC/ACR-DI) increase or death. Main explanatory variables were smoking status and pack-years. Covariates included age, sex, race, ethnicity, receipt of Medicaid, neighborhood area deprivation index, and baseline SLE damage. Damage increase-free survival was evaluated by smoking status and pack-years using Kaplan-Meier and Cox proportional hazards methods.

RESULTS

Patients of Black race and Medicaid recipients were more commonly current smokers ('s < 0.05). Former smokers were older and more likely to have late-onset SLE (54% versus 33% of never and 29% of current smokers, = 0.001). Median time to SLICC/ACR-DI increase or death was earlier in current or former compared to never smokers (4.5 and 3.4 versus 9.0 yrs; = 0.002). In multivariable models, the rate of damage accumulation was twice as fast in current smokers (HR 2.18; 1.33, 3.57) and smokers with a >10 pack-year history (HR 2.35; 1.15, 3.64) versus never smokers.

CONCLUSIONS

In this incident SLE cohort, past or current smoking predicted new SLE damage 4-5 years earlier. After adjustment, current smokers and patients with a pack-year history of >10 years accumulated damage at twice the rate of never smokers.

摘要

目的

研究吸烟史和吸烟年支暴露与系统性红斑狼疮（SLE）终末器官损害发生率的关系。

方法

SLE 发病队列纳入了满足美国风湿病学会（ACR）1997 年或 SLE 国际协作临床（SLICC）2012 年 SLE 标准，并在美国学术机构（2008-16 年）有风湿科就诊记录的患者。主要结局是 SLICC/ACR 损害指数（SLICC/ACR-DI）增加或死亡的中位数时间。主要解释变量为吸烟状况和吸烟年支。协变量包括年龄、性别、种族、民族、是否接受医疗补助、邻里剥夺指数和基线 SLE 损害。采用 Kaplan-Meier 和 Cox 比例风险方法评估吸烟状况和吸烟年支对无损害生存的影响。

结果

黑人和接受医疗补助的患者中，当前吸烟者更为常见（P<0.05）。与从不吸烟者和当前吸烟者相比，以前吸烟者年龄更大，更可能患有晚发性 SLE（54%比 33%和 29%，P=0.001）。与从不吸烟者相比，当前吸烟者和以前吸烟者的 SLICC/ACR-DI 增加或死亡的中位时间更早（4.5 年和 3.4 年比 9.0 年；P=0.002）。在多变量模型中，当前吸烟者（HR 2.18；1.33，3.57）和吸烟年支>10 年者（HR 2.35；1.15，3.64）的损害累积速度是从不吸烟者的两倍。