Koepsell T D, Daling J R, Weiss N S, Taylor J W, Olshan A F, Lyon J L, Swanson G M, Child M
Department of Epidemiology, University of Washington, Seattle 98195.
Am J Epidemiol. 1987 Dec;126(6):1051-62. doi: 10.1093/oxfordjournals.aje.a114744.
To evaluate whether potent or prolonged stimulation of the immune system increases the risk of multiple myeloma, the authors compared 698 myeloma cases which occurred between July 1, 1977 and June 30, 1981 in four geographic areas of the United States with 1,683 demographically similar controls from the same areas. Cases and controls were interviewed about past exposures which may have involved antigenic challenge. Although few positive associations emerged, those most consistent with the immune stimulation hypothesis were modest associations between myeloma and a history of rheumatic fever (relative risk (RR) = 1.74, 95% confidence interval (CI) = 1.09-2.77) and between myeloma and urinary tract infection (RR = 1.30, 95% CI = 1.00-1.69, when self-respondent cases were compared with controls). Little association was found between the risk of myeloma and the number of past viral illnesses, number of bacterial illnesses, or number of allergy desensitization injections. Myeloma risk was found to be inversely related to the number of diseases against which a subject reported having been immunized, perhaps because of differences in socioeconomic status between cases and controls. These findings provide little support for the immune system stimulation hypothesis of myeloma etiology, but because of the limitations of interview techniques for assessing antigen exposure, further studies using laboratory methods may be warranted.
为评估免疫系统的强烈或长期刺激是否会增加多发性骨髓瘤的风险，作者将1977年7月1日至1981年6月30日期间在美国四个地理区域发生的698例骨髓瘤病例与来自同一区域的1683名人口统计学特征相似的对照进行了比较。就可能涉及抗原刺激的既往暴露情况对病例和对照进行了访谈。虽然几乎没有出现明显的正相关，但与免疫刺激假说最相符的是骨髓瘤与风湿热病史之间的适度关联（相对风险（RR）=1.74，95%置信区间（CI）=1.09-2.77）以及骨髓瘤与尿路感染之间的适度关联（当将自我报告的病例与对照进行比较时，RR = 1.30，95% CI = 1.00-1.69）。在骨髓瘤风险与既往病毒感染次数、细菌感染次数或过敏脱敏注射次数之间未发现明显关联。发现骨髓瘤风险与受试者报告已接种疫苗的疾病数量呈负相关，这可能是由于病例和对照之间社会经济地位的差异。这些发现几乎无法支持骨髓瘤病因的免疫系统刺激假说，但由于评估抗原暴露的访谈技术存在局限性，可能有必要采用实验室方法进行进一步研究。
