Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Liver Int. 2021 Oct;41(10):2396-2403. doi: 10.1111/liv.14944. Epub 2021 May 28.
Failure of immunologic homeostasis and resultant hepatocyte destruction in autoimmune hepatitis (AIH) is likely the result of environmental triggers within a permissive genetic architecture.
We aimed to identify risk factors associated with AIH in a well-phenotyped AIH cohort.
We prospectively collected environmental questionnaires from 358 AIH cases and 563 healthy controls. Response frequencies were compared using logistic regression, adjusting for age at recruitment, sex and education.
AIH cases were more likely to ever have a urinary tract infection (UTI) (53.6% vs 33.9%, P < .001) and recurrent UTI (more than 1 per year) (23.5% vs 15.9%, P = .002) compared to controls. Female cases more frequently had ever used oral contraceptives (83.0% vs 73.7%, P = .006), fewer pregnancies (median = 1 vs 3, P < .001) and less often used hormone replacement therapy compared to controls (28.5% vs 60.1%, P < .001). Current smoking was more prevalent in cases (18.9% vs 7.4%, P = .022), yet no difference according to historical smoking behaviours was observed. Finally, cases were less likely to have history of mumps (32.4% vs 53.1%, P = .011) and rheumatic fever (1.1% vs 4.4%, P = .028), but reported higher vaccination frequency to chicken pox (38% vs 28.1%), measles (66.5% vs 39.3%), mumps (58.7% vs 34.6%), rubella (55.3% vs 32.7%), pertussis (59.8% vs 40.1%) and pneumococcus (47.2% VS 39.4%) (P < .002).
Environmental factors are important in AIH pathogenesis. Replication of these findings and prospective examination may provide new insight into AIH onset and outcomes.
自身免疫性肝炎（AIH）中免疫稳态的失败和由此导致的肝细胞破坏很可能是环境触发因素在允许的遗传结构中的结果。
我们旨在确定在表型良好的 AIH 队列中与 AIH 相关的危险因素。
我们前瞻性地从 358 例 AIH 病例和 563 例健康对照中收集环境问卷。使用逻辑回归比较反应频率，调整招募时的年龄、性别和教育程度。
与对照组相比，AIH 病例更有可能曾患有尿路感染（UTI）（53.6% vs 33.9%，P<0.001）和复发性 UTI（每年超过 1 次）（23.5% vs 15.9%，P=0.002）。女性病例更频繁地使用过口服避孕药（83.0% vs 73.7%，P=0.006）、妊娠次数较少（中位数=1 次 vs 3 次，P<0.001），且与对照组相比，使用激素替代疗法的频率较低（28.5% vs 60.1%，P<0.001）。目前吸烟的病例更为常见（18.9% vs 7.4%，P=0.022），但未观察到吸烟史的差异。最后，病例发生腮腺炎（32.4% vs 53.1%，P=0.011）和风湿热（1.1% vs 4.4%，P=0.028）的病史较少，但报告水痘（38% vs 28.1%）、麻疹（66.5% vs 39.3%）、腮腺炎（58.7% vs 34.6%）、风疹（55.3% vs 32.7%）、百日咳（59.8% vs 40.1%）和肺炎球菌（47.2% vs 39.4%）的疫苗接种频率更高（P<0.002）。
环境因素在 AIH 的发病机制中很重要。这些发现的复制和前瞻性检查可能为 AIH 的发病和结果提供新的见解。
