Bourguet C C, Logue E E
Division of Community Health Sciences, Northeastern Ohio Universities College of Medicine, Rootstown 44272.
Cancer. 1993 Oct 1;72(7):2148-54. doi: 10.1002/1097-0142(19931001)72:7<2148::aid-cncr2820720714>3.0.co;2-q.
A causal relationship between antigenic conditions and multiple myeloma was suggested by case reports. Although controlled studies identified associations with individual conditions, they failed to give overall support to the hypothesis. Using a prospective cohort representative of the U.S. population, the authors hypothesized that immune-stimulating conditions are a risk factor for multiple myeloma.
The First National Health and Nutrition Examination Survey cohort of 14,407 persons were interviewed from 1971 to 1975 by the National Center for Health Statistics. Vital status with cause of death and hospitalizations were ascertained from 1982 to 1985 and in 1986. From the initial questionnaire, four risk factors were constructed: allergies (asthma, hives, hay fever, food allergies, and other allergies); autoimmune conditions (arthritis, thyroid disease and/or medication, rheumatic fever, diabetes, pernicious anemia); chronic bacterial conditions (chronic bronchitis or emphysema, chronic cough, tuberculosis, ulcers); and inflammatory conditions (gout, gallstones, recurrent or chronic enteritis, pleurisy).
Eighteen multiple myeloma (MM) cases were documented. The rate ratio (RR) of MM increased as the number of reported inflammatory conditions increased (one condition, RR = 2.0, 95% confidence interval [CI] = 1.2-3.3; 2 or more conditions, RR = 4.3, 95% CI = 1.5-12.4). The RR of myeloma also increased (P = 0.0002) with time since start of inflammatory conditions (RR = 1.6 for every 10 years of exposure). When cases were restricted to those with more than five years of follow-up, myeloma risk increased with the number of inflammatory conditions (two conditions, RR = 4.6, 95% CI = 1.5-13.8).
Although the number of cases is small and exposure may be misclassified, the prospective nature of the study design strengthens the results of the study.
病例报告提示抗原状况与多发性骨髓瘤之间存在因果关系。尽管对照研究确定了与个别状况的关联，但它们未能为该假设提供全面支持。作者利用一个代表美国人群的前瞻性队列，假设免疫刺激状况是多发性骨髓瘤的一个危险因素。
1971年至1975年期间，美国国家卫生统计中心对首份全国健康和营养检查调查队列中的14407人进行了访谈。1982年至1985年以及1986年确定了死亡原因和住院情况的生命状态。根据初始问卷构建了四个危险因素：过敏（哮喘、荨麻疹、花粉热、食物过敏和其他过敏）；自身免疫性疾病（关节炎、甲状腺疾病和/或药物、风湿热、糖尿病、恶性贫血）；慢性细菌感染（慢性支气管炎或肺气肿、慢性咳嗽、肺结核、溃疡）；以及炎症性疾病（痛风、胆结石、复发性或慢性肠炎、胸膜炎）。
记录了18例多发性骨髓瘤（MM）病例。随着报告的炎症性疾病数量增加，MM的发病率比（RR）升高（一种疾病时，RR = 2.0，95%置信区间[CI] = 1.2 - 3.3；两种或更多疾病时，RR = 4.3，95%CI = 1.5 - 12.4）。骨髓瘤的RR也随着炎症性疾病开始后的时间增加（P = 0.0002）（每暴露10年RR = 1.6）。当病例限于随访超过五年的患者时，骨髓瘤风险随着炎症性疾病数量增加（两种疾病时，RR = 4.6，95%CI = 1.5 - 13.8）。
尽管病例数量较少且暴露情况可能分类错误，但研究设计的前瞻性加强了研究结果。
