Hubers Lowiek M, Schuurman Alex R, Buijs Jorie, Mostafavi Nahid, Bruno Marco J, Vermeulen Roel C H, Huss Anke, van Buuren Henk R, Beuers Ulrich
Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, location AMC, AGEM, Amsterdam, The Netherlands.
Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
JHEP Rep. 2021 Oct 9;3(6):100385. doi: 10.1016/j.jhepr.2021.100385. eCollection 2021 Dec.
BACKGROUND & AIMS: Immunoglobulin G4-related disease (IgG4-RD) of the biliary tract and pancreas is a fibroinflammatory disease of unknown origin with striking male predominance. We aimed to investigate whether blue-collar work and occupational contaminant exposure are risk factors for IgG4-RD of the biliary tract and pancreas.
We performed an age-/sex-matched case-control study in the largest academic medical centers of the Netherlands. Occupational history was surveyed by questionnaires. The International Standard Classification of Occupations (ISCO88) was used to classify jobs. Job exposure matrices and were utilized to assess the years individuals were exposed to compounds. The disease control cohort consisted of patients from 6 equally sized groups. Conditional logistic regression was used to assess effects of blue-collar work and exposure to occupational contaminants on developing IgG4-RD of the biliary tract and pancreas.
Overall, 101 patients with IgG4-RD of the biliary tract and pancreas were matched 1:3 to 303 controls. Patients with IgG4-RD had a lower level of education ( = 0.001). Individuals who at least once performed blue-collar work (>1 year), had higher odds of developing IgG4-RD than individuals that only performed white-collar work (odds ratio [OR] 3.66; CI 2.18-6.13; 0.0001). Being ever exposed (>1 year) to industrial ( mineral dust; vapors-dust-gases-fumes) and compounds ( asbestos) resulted in higher odds of IgG4-RD (OR 2.14; 95% CI 1.26-3.16; 0.001 and OR 2.95; 95% CI 1.78-4.90; 0.001, respectively).
Blue-collar work is a risk factor for developing IgG4-RD of the biliary tract and pancreas putatively driven by exposure to selected industrial compounds; this may explain the striking male predominance among patients.
Immunoglobulin G4-related disease (IgG4-RD) causes tumor-like lesions and typically affects middle-aged to elderly men. The background and cause of this disease remain relatively unknown. In this study, we identified blue-collar work as a risk factor for developing IgG4-RD of the biliary tract and pancreas, which may explain the striking male predominance among patients. Furthermore, these results suggest that toxic exposure to occupational contaminants may drive autoimmunity in IgG4-RD of the biliary tract and pancreas.
胆道和胰腺的免疫球蛋白G4相关疾病（IgG4-RD）是一种病因不明的纤维炎症性疾病，男性患者居多。我们旨在研究蓝领工作和职业污染物暴露是否为胆道和胰腺IgG4-RD的危险因素。
我们在荷兰最大的学术医疗中心进行了一项年龄/性别匹配的病例对照研究。通过问卷调查职业史。使用国际职业标准分类（ISCO88）对工作进行分类。利用工作暴露矩阵评估个体接触化合物的年限。疾病对照队列由来自6个规模相等组别的患者组成。采用条件逻辑回归评估蓝领工作和职业污染物暴露对发生胆道和胰腺IgG4-RD的影响。
总体而言，101例胆道和胰腺IgG4-RD患者与303例对照按1:3匹配。IgG4-RD患者的教育水平较低（P = 0.001）。至少有一次从事蓝领工作（>1年）的个体发生IgG4-RD的几率高于仅从事白领工作的个体（比值比[OR] 3.66；可信区间2.18 - 6.13；P = 0.0001）。曾经暴露（>1年）于工业粉尘（矿物粉尘；蒸汽 - 粉尘 - 气体 - 烟雾）和石棉化合物导致IgG4-RD的几率更高（OR分别为2.14；95%可信区间1.26 - 3.16；P = 0.001和OR 2.95；95%可信区间1.78 - 4.90；P = 0.001）。
蓝领工作是发生胆道和胰腺IgG4-RD的一个危险因素，可能是由于接触特定工业化合物所致；这可能解释了患者中男性居多的现象。
免疫球蛋白G4相关疾病（IgG4-RD）会导致肿瘤样病变，通常影响中年至老年男性。这种疾病的背景和病因仍然相对不明。在本研究中，我们确定蓝领工作是发生胆道和胰腺IgG4-RD的一个危险因素，这可能解释了患者中男性居多的现象。此外，这些结果表明，职业污染物的毒性暴露可能在胆道和胰腺IgG4-RD中引发自身免疫。
