Chen Zhiyong, Cui Ran, Wang Shiow-Ing, Zhang Hua, Chen Miao, Wang Qian, Tong Qiang, Wei James Cheng-Chung, Dai Sheng-Ming
Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Medical Research, Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan.
Int J Epidemiol. 2024 Dec 16;54(1). doi: 10.1093/ije/dyae167.
Although autoimmune abnormalities are common in patients with endometriosis, it is unknown whether patients with endometriosis have a higher risk of developing antiphospholipid syndrome (APS).
We conducted a retrospective cohort study by using the multi-institutional research network TriNetX from 1 January 2012 to 31 December 2021. A total of 13 131 782 women aged 20-60 years from networks within the USA were included. The risks of APS were compared between an endometriosis cohort and a non-endometriosis cohort in subgroup analyses by age, obesity and systemic lupus erythematosus (SLE), and the sensitivity analysis was stratified by the presence or absence of a history of surgery of the uterus.
After 1:1 propensity score matching, the endometriosis and non-endometriosis cohorts each included 50 078 participants. Compared to individuals without endometriosis, patients with endometriosis had a higher risk of incident APS (log-rank test, P < 0.001). The hazard ratios (HRs) ranged from 1.82 [APS within 30 days to 1 year after the index date, 95% confidence intervals (CIs) 1.40-2.53] to 2.44 (APS within 30 days to any time after the index date, 95% CI 1.65-3.61). In the subgroup analyses, an increased risk of APS was observed in all ages, White race, and subgroups without smoking, obesity, asthma, inflammatory bowel disease and SLE (HR range 1.85-2.84). Sensitivity analyses revealed that the risk of APS increased in patients without surgery history of the uterus.
Patients with endometriosis had a higher risk (2.84-fold) of developing APS. Future large-scale prospective studies are warranted to confirm our results.
虽然自身免疫异常在子宫内膜异位症患者中很常见，但子宫内膜异位症患者发生抗磷脂综合征（APS）的风险是否更高尚不清楚。
我们利用多机构研究网络TriNetX进行了一项回顾性队列研究，时间跨度为2012年1月1日至2021年12月31日。纳入了美国各网络中13131782名年龄在20至60岁之间的女性。在亚组分析中，按年龄、肥胖和系统性红斑狼疮（SLE）比较了子宫内膜异位症队列和非子宫内膜异位症队列发生APS的风险，并根据有无子宫手术史进行分层的敏感性分析。
经过1:1倾向评分匹配后，子宫内膜异位症队列和非子宫内膜异位症队列各纳入50078名参与者。与无子宫内膜异位症的个体相比，子宫内膜异位症患者发生APS的风险更高（对数秩检验，P<0.001）。风险比（HR）范围从1.82[索引日期后30天至1年内发生APS，95%置信区间（CI）1.40 - 2.53]到2.44（索引日期后30天至任何时间发生APS，95%CI 1.65 - 3.61）。在亚组分析中，各年龄段、白人种族以及无吸烟、肥胖、哮喘、炎症性肠病和SLE的亚组中均观察到APS风险增加（HR范围1.85 - 2.84）。敏感性分析显示，无子宫手术史的患者发生APS的风险增加。
子宫内膜异位症患者发生APS的风险更高（2.84倍）。未来需要大规模前瞻性研究来证实我们的结果。
