目的：既往研究提示，係統性紅斑狼瘡女性罹患宮頸癌的風險增加。但是免疫抑製劑的應用與宮頸癌之間的關係並未在美國全國隊列中進行充分研究。本研究比較了初始應用免疫抑製劑治療與應用羥氯喹治療的SLE女性罹患宮頸重度異性增生與宮頸癌的風險之間的差別。
方法：我們研究對象為兩個健康計劃及醫療計劃中自2000至2012年應用免疫抑製劑或羥氯喹的狼瘡女性患者。我們應用嚴格標準定義宮頸重度不典型增生以及宮頸癌。評估可能的幹擾因素，如人口統計學因素，合並症，用藥因素，HPV疫苗接種情況以及健康保健情況。經傾向性指數匹配後初始應用免疫抑製劑及羥氯喹的患者比例為1:1.應用反向方差加權，固定效應模型計算兩組患者的風險比。
結果：在商業隊列中我們共納入2451對初始應用免疫抑製劑及初始應用羥氯喹的配對患者，在醫療隊列中納入了7690對患者。在商業隊列中，應用免疫抑製劑組共有14例患者出現宮頸重度不典型增生或宮頸癌，而羥氯喹組出現了5例(HR 2.47, 95% CI 0.89-6.85, 羥氯喹 = ref)。在醫療隊列組，免疫抑製劑組出現宮頸重度不典型增生或宮頸癌共46例，羥氯喹組為29例(HR 1.24, 95% CI 0.78-1.98, 羥氯喹= ref).免疫抑製劑組與羥氯喹組比風險比為1.40(95% CI 0.92-2.12).
結論：對於狼瘡女性患者而言，與應用羥氯喹的患者相比，應用免疫抑製劑的患者可能具有罹患宮頸重度不典型增生和宮頸癌的更高風險，雖然這種風險還不具有顯著統計學差異。
附原文：
Abstract：Objective Prior studies suggest anincreased risk of cervical cancer among women with systemic lupus erythematosus.However, the relationship with immunosuppressive drugs is notwell studied in US nationwide cohorts. We comparedthe risk of high-grade cervical dysplasia and cervical cancer among women with systemic lupus erythematosus whostarted immunosuppressive drugs versus hydroxychloroquine.Methods We identified systemic lupus erythematosus patientsinitiating immunosuppressive drugs or hydroxychloroquine usingclaims data from two US commercial health plans and Medicaid (2000-2012). Weused a validated claims-based algorithm to identify high-grade cervical dysplasia or cervical cancer.To account for potential confounders, including demographic factors,comorbidities, medication use, HPV vaccination status, and health careutilization, immunosuppressive drugs and hydroxychloroquineinitiators were 1:1 matched on the propensity score. We used inverse variance-weighted,fixed effect models to pool hazard ratios from the propensity score-matchedMedicaid and commercial cohorts. Results We included 2451 matched pairs of immunosuppressive drugs andhydroxychloroquine new users in the commercial cohort and 7690 matched pairs inMedicaid. In the commercial cohort, there were 14 casesof cervical dysplasia or cervical cancer among immunosuppressive drugs usersand five cases among hydroxychloroquine users (hazard ratio 2.47,95% CI 0.89-6.85, hydroxychloroquine=ref). In Medicaid,there were 46 cases among immunosuppressive drugs users and 29cases in hydroxychloroquine users (hazard ratio 1.24, 95% CI 0.78-1.98,hydroxychloroquine=ref). The pooled hazardratio of immunosuppressive drugs was 1.40 (95% CI 0.92-2.12). ConclusionAmong women with systemic lupus erythematosus, immunosuppressive drugs maybe associated with a greater, albeit not statisticallysignificant, risk of high-grade cervical dysplasia and cervical cancer comparedto patients receiving hydroxychloroquine alone.
引自：
Feldman CH, Liu J, Feldman S,et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic lupuserythematosus receiving immunosuppressive drugs.Lupus. 2017 Jun;26(7):682-689.
