Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.
J Eur Acad Dermatol Venereol. 2023 Jun;37(6):1190-1198. doi: 10.1111/jdv.18841. Epub 2023 Jan 25.
Lymphocyte skin homing in atopic eczema (AE) may induce lymphopenia.
To determine if AE is associated with lymphopenia.
We used UK primary care electronic health records (Clinical Practice Research Datalink GOLD) for a matched cohort study in adults (18 years+) (1997-2015) with at least one recorded lymphocyte count. We matched people with AE to up to five people without. We used multivariable logistic regression to estimate the association between AE and lymphopenia (two low lymphocyte counts within 3 months) and linear mixed effects regression to estimate the association with absolute lymphocyte counts using all available counts. Cox proportional hazard models were used to investigate the effect of lymphopenia on common infections. We replicated the study using US survey data (National Health and Nutrition Examination Survey [NHANES]).
Among 71,731 adults with AE and 126,349 adults without AE, we found an adjusted odds ratio (OR) for lymphopenia of 1.16 (95% CI: 1.09-1.23); the strength of association increased with increasing eczema severity. When comparing all recorded lymphocyte counts from adults with AE (n = 1,497,306) to those of people without AE (n = 4,035,870) we saw a lower mean lymphocyte (adjusted mean difference -0.047 × 10 /L [95% CI: -0.051 to -0.043]) in those with AE. The difference was larger for men, with increasing age, and with increasing AE severity and was present among people with AE not treated with immunosuppressive drugs. In NHANES (n = 22,624), the adjusted OR for lymphopenia in adults with AE was 1.30 (95% CI: 0.80-2.11), and the adjusted mean lymphocyte count difference was -0.03 × 10 /L (95% CI: -0.07 to 0.02). Despite having a lower lymphocyte count, adjusting for time with lymphopenia, did not alter risk estimates of infections.
Atopic eczema, including increasing AE severity, is associated with a decreased lymphocyte count, regardless of immunosuppressive drug use. Whether the lower lymphocyte count has wider health implications for people with severe eczema warrants further investigation.
特应性皮炎（AE）中的淋巴细胞皮肤归巢可能导致淋巴细胞减少症。
确定 AE 是否与淋巴细胞减少症相关。
我们使用英国初级保健电子健康记录（临床实践研究数据链接 GOLD）进行了一项匹配队列研究，纳入了至少有一次记录的淋巴细胞计数的成年人（18 岁以上）（1997-2015 年）。我们将患有 AE 的人与多达五名无 AE 的人进行匹配。我们使用多变量逻辑回归来估计 AE 与淋巴细胞减少症（3 个月内两次低淋巴细胞计数）之间的关联，并使用所有可用计数的线性混合效应回归来估计与绝对淋巴细胞计数的关联。Cox 比例风险模型用于研究淋巴细胞减少症对常见感染的影响。我们使用美国调查数据（国家健康和营养检查调查[NHANES]）复制了这项研究。
在 71731 名患有 AE 的成年人和 126349 名没有 AE 的成年人中，我们发现淋巴细胞减少症的调整后比值比（OR）为 1.16（95%CI：1.09-1.23）；关联强度随着湿疹严重程度的增加而增加。当比较患有 AE 的成年人（n=1497306）和没有 AE 的成年人（n=4035870）的所有记录的淋巴细胞计数时，我们发现患有 AE 的成年人的平均淋巴细胞计数较低（调整后的平均差异-0.047×10 /L [95%CI：-0.051 至-0.043]）。对于男性、年龄较大、AE 严重程度较高的人群，差异更大，并且在未接受免疫抑制药物治疗的 AE 人群中也存在这种情况。在 NHANES（n=22624）中，AE 成年人淋巴细胞减少症的调整后 OR 为 1.30（95%CI：0.80-2.11），调整后的平均淋巴细胞计数差异为-0.03×10 /L（95%CI：-0.07 至 0.02）。尽管淋巴细胞计数较低，但调整淋巴细胞减少症的时间并不会改变感染风险的估计值。
特应性皮炎，包括 AE 严重程度的增加，与淋巴细胞计数降低有关，无论是否使用免疫抑制药物。较低的淋巴细胞计数是否对严重湿疹患者有更广泛的健康影响，还需要进一步研究。
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