背景:已发现室外空气污染会引发全身性炎症反应并加重某些风湿性疾病的活动。然而,很少有研究探讨空气污染对强直性脊柱炎(AS)活动的影响。由于在台湾患有活动性AS的患者可以通过国民健康保险计划获得生物治疗的报销,我们调查了空气污染物与活性AS开始报销生物制剂之间的关联.
方法:自2011年以来,环境空气污染物的每小时浓度,包括PM2.5、PM10、NO2、CO、台湾已估计有SO2和O3。使用台湾国民健康保险研究数据库,我们确定了2003年至2013年新诊断的AS患者.我们选择了2012年至2013年的584名开始使用生物制剂的患者和2336名性别-生物学开始时的年龄-,AS诊断年份和疾病持续时间匹配的对照。我们在生物使用前1年内检查了生物制剂开始与空气污染物暴露的关联,同时调整了潜在的混杂因素。包括疾病持续时间,城市化水平,月收入,Charlson合并症指数(CCI),葡萄膜炎,牛皮癣和AS药物的使用。结果显示为具有95%置信区间(CI)的调整比值比(aOR)。
结果:生物制剂的开始与暴露于CO(每1ppm)有关(aOR,8.57;95%CI,2.02-36.32)和NO2(每10ppb)(aOR,0.23;95%CI,0.11-0.50)。其他独立预测因素包括疾病持续时间(增量年,OR,8.95),CCI(aOR,1.31),牛皮癣(aOR,25.19),使用非甾体抗炎药(aOR,23.66),使用甲氨蝶呤(aOR,4.50;95%CI,2.93-7.00),柳氮磺吡啶使用(aOR,12.16;95%CI,8.98-15.45)和泼尼松龙等效剂量(毫克/天,OR,1.12).
结论:全国范围内,基于人群的研究表明,报销生物制剂的启动与CO水平呈正相关,但与NO2水平呈负相关。主要限制包括缺乏有关个人吸烟状况的信息以及空气污染物之间的多重共线性。
Outdoor air pollution has been found to trigger systemic inflammatory responses and aggravate the activity of certain rheumatic diseases. However, few studies have explored the influence of air pollution on the activity of ankylosing spondylitis (AS). As patients with active AS in Taiwan can be reimbursed through the National Health Insurance programme for biological therapy, we investigated the association between air pollutants and the initiation of reimbursed biologics for active AS.
Since 2011, hourly concentrations of ambient air pollutants, including PM2.5, PM10, NO2, CO, SO2, and O3, have been estimated in Taiwan. Using Taiwanese National Health Insurance Research Database, we identified patients with newly diagnosed AS from 2003 to 2013. We selected 584 patients initiating biologics from 2012 to 2013 and 2336 gender-, age at biologic initiation-, year of AS diagnosis- and disease duration-matched controls. We examined the associations of biologics initiation with air pollutants exposure within 1 year prior to biologic use whilst adjusting for potential confounders, including disease duration, urbanisation level, monthly income, Charlson comorbidity index (CCI), uveitis, psoriasis and the use of medications for AS. Results are shown as adjusted odds ratio (aOR) with 95% confidence intervals (CIs).
The initiation of biologics was associated with exposure to CO (per 1 ppm) (aOR, 8.57; 95% CI, 2.02-36.32) and NO2 (per 10 ppb) (aOR, 0.23; 95% CI, 0.11-0.50). Other independent predictors included disease duration (incremental year, aOR, 8.95), CCI (aOR, 1.31), psoriasis (aOR, 25.19), use of non-steroidal anti-inflammatory drugs (aOR, 23.66), methotrexate use (aOR, 4.50; 95% CI, 2.93-7.00), sulfasalazine use (aOR, 12.16; 95% CI, 8.98-15.45) and prednisolone equivalent dosages (mg/day, aOR, 1.12).
This nationwide, population-based study revealed the initiation of reimbursed biologics was positively associated with CO levels, but negatively associated with NO2 levels. Major limitations included lack of information on individual smoking status and multicollinearity amongst air pollutants.