Institute of Rheumatology, Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, China.
Institute of Biochemistry and Immunology, Chung Shan Medical University, Taichung, Taiwan.
Front Immunol. 2022 Jun 15;13:877942. doi: 10.3389/fimmu.2022.877942. eCollection 2022.
Previous research has shown a possible relationship between endometriosis and autoimmune diseases. However, the relationship between endometriosis and ankylosing spondylitis (AS) is lacking. Therefore, we intended to find possible associations between endometriosis and AS using ICD-9 coding data in a population-based retrospective cohort study in Taiwan.
Data for this retrospective cohort study were collected from the Taiwan National Health Insurance Research Database (NHIRD) between 2000-2012. We collected 13,145 patients with endometriosis and a 78,870 non-endometriosis comparison cohort. Diagnoses of endometriosis and AS were defined by the International Classification of Diseases-9 (ICD-9-CM) code for at least 3 outpatients or 1 hospitalization. Propensity score matching by comorbidities, corticosteroids, and non-steroidal anti-inflammatory drugs (NSAIDs) usage were done for baseline comparability. Cox proportional hazard models were used to evaluate crude and adjusted hazard ratios.
The cumulative incidence of AS was higher in patients with endometriosis compared to the non-endometriosis comparison cohort (log-rank test, p = 0.015). The adjusted hazard ratio (aHR) of incidental AS in patients with endometriosis was 1.61 (95% CI = 1.11 to 2.35) in comparison to the non-endometriosis comparison cohort. An increased risk of AS was also observed in subjects with major depressive disorder (aHR = 5.05, 95% CI = 1.85 to 13.78). Stratified analyses of age subgroups showed consistent results. NSAID users had a lower risk of AS than NSAID non-users (aHR 4.57 vs 1.35, p for interaction = 0.031).
In this retrospective population-based cohort study, we found a higher risk of AS in patients with endometriosis. We suggest that clinicians should pay attention to the occurrence of AS in patients with endometriosis.
既往研究表明子宫内膜异位症与自身免疫性疾病之间可能存在关联。然而，子宫内膜异位症与强直性脊柱炎（AS）之间的关系尚不清楚。因此，我们拟通过在台湾基于人群的回顾性队列研究中使用国际疾病分类第 9 版（ICD-9）编码数据来寻找子宫内膜异位症与 AS 之间的可能关联。
本回顾性队列研究的数据来自 2000 年至 2012 年台湾全民健康保险研究数据库（NHIRD）。我们收集了 13145 例子宫内膜异位症患者和 78870 例非子宫内膜异位症对照组。子宫内膜异位症和 AS 的诊断均通过至少 3 次门诊或 1 次住院的国际疾病分类第 9 版（ICD-9-CM）代码来确定。根据合并症、皮质类固醇和非甾体抗炎药（NSAIDs）使用情况进行倾向评分匹配以实现基线可比性。使用 Cox 比例风险模型评估粗风险比和调整风险比。
与非子宫内膜异位症对照组相比，子宫内膜异位症患者的 AS 累积发病率更高（对数秩检验，p = 0.015）。与非子宫内膜异位症对照组相比，子宫内膜异位症患者的意外 AS 调整风险比（aHR）为 1.61（95%CI=1.11 至 2.35）。在患有重度抑郁症的患者中也观察到 AS 发病风险增加（aHR=5.05，95%CI=1.85 至 13.78）。年龄亚组的分层分析结果一致。与 NSAID 非使用者相比，NSAID 使用者发生 AS 的风险较低（aHR=4.57 与 1.35，p 交互=0.031）。
在这项回顾性基于人群的队列研究中，我们发现子宫内膜异位症患者发生 AS 的风险较高。我们建议临床医生应注意子宫内膜异位症患者发生 AS 的情况。
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