石棉相关自身免疫病研究进展

Research progress on asbestos-associated autoimmune diseases

石棉相关自身免疫病(AID)是一组吸入石棉纤维引起的疾病,包括良性胸膜疾病、石棉肺以及间皮瘤和肺癌等恶性肿瘤,伴结缔组织病和抗中性粒细胞胞浆抗体(ANCN)相关性血管炎等。石棉接触可导致异质性疾病,如类风湿性关节炎、系统性红斑狼疮、系统性硬化症、ANCN相关性血管炎等AID。除合并AID外,石棉接触还可引起多种自身抗体阳性,包括血清类风湿因子、ANCA、抗核抗体、抗可提取性核抗原抗体、抗核糖核蛋白抗体、抗硬皮病70抗体、抗dsDNA抗体、抗组蛋白抗体、抗核糖体P蛋白抗体、抗史密斯抗体等。角闪石较温石棉更易引起自身免疫反应。石棉可通过诱导产生自身抗体和诱导肺泡巨噬细胞异常,从而导致自身免疫;石棉还可通过诱导产生自身抗体从而促进肺纤维化。石棉接触引发AID的发病机制尚未完全阐明,但可以肯定的是石棉接触诱导了局部和全身性固有免疫和适应性免疫障碍,导致自身抗体的产生,造成系统性损害。

Asbestos-associated autoimmune disease(AID) refers to a group of diseases caused by inhalation of asbestos fibers, including benign pleural disease, asbestosis and malignancies such as mesothelioma and lung cancer, with AIDs such as connective tissue disease and anti-neutrophil cytoplasmic antibody(ANCA) associated vasculitis. Asbestos exposure can lead to a heterogeneous group of diseases such as rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, ANCA-related vasculitis and other AIDs. In addition to combined AID, asbestos exposure can also cause the generation of a variety of autoantibodies, including rheumatoid factor, ANCA, anti-nuclear antibody, anti-extractable nuclear antigen antibody, anti-ribonucleoprotein antibody, anti-scleroderma 70 antibody, anti-dsDNA antibody, anti-histone antibody, anti-ribosomal P protein antibody, anti-Smith antibody, and more. Hornblende is more likely to cause an autoimmune reaction than chrysotile. Asbestos can lead to autoimmune diseases by inducing autoantibodies and abnormal alveolar macrophages. Asbestos can also promote pulmonary fibrosis by inducing the production of autoantibodies. The pathogenesis of AID caused by asbestos exposure has not been fully elucidated, but it is confirmed that asbestos exposure induces local and systemic innate and adaptive immune disorders, leading to production of autoantibodies and cause systemic damage.