环境空气污染对自身免疫病影响的系统评价

Ambient air pollution in the development and exacerbation of autoimmune diseases:a systematic review of literature

目的评价环境空气污染对自身免疫病的影响。方法从EMBASE,Scopus,PubMed和Cochrane数据库中检索发表的有关环境空气污染与自身免疫病关联的相关文献,检索时段从建库至2019年7月,最终纳入文献24篇。由于各研究间方法学异质性大,遂未进行Meta分析,仅对结果进行定性分析。结果共纳入24篇文献,包括RA 6例,ANCA相关性血管炎(AAV)1例,AS 1例,SLE 3例,儿童起病的SLE(cSLE)3例,幼年特发性关节炎(JIA)2例,川崎病4例和系统性自身免疫病(SARD)4例。分析结果表明,短期暴露于PM2.5可能会增加SLE、cSLE、AS、JIA、SARD恶化的风险。长期接触一氧化碳,二氧化氮,臭氧和二氧化硫会增加患RA的风险。臭氧水平升高会增加川崎病患者住院的风险,而AAV与环境空气污染之间不存在相关性。结论环境空气污染可能与某些自身免疫病的发病有关。建议未来通过开展更多研究来评估空气污染与自身免疫病的关系,同时积极开展空气污染物与自身免疫病的机制研究,达到进行早期预防自身免疫病的目的。

Objective To systematically evaluate the role of air pollutants in the development and exacerbation of autoimmune rheumatic diseases.Methods We followed PRISMA guidelines and searched EMBASE,Scopus,PubMed,and Cochrane Library databases using keywords and MeSH terms from inception to July 2019.Observational studies reporting the relationship between autoimmune rheumatic diseases and exposure to certain air pollutants were included.Screening of literature according to established inclusion and exclusion criteria.No meta-analysis but the qualitative analysis was conducted due to the high methodological heterogeneity.Results A total of 24 studies were included.Rheumatoid arthritis(RA)(n=6),anti-neutrophil cytoplasmic antibodies(ANCA)-associated vasculitis(AAV)(n=1),ankylosing spondylitis(AS)(n=1),systemic lupus erythematosus(SLE)(n=3),childhood-onset systemic lupus erythematosus(cSLE)(n=3),juvenile idiopathic arthritis(JIA)(n=2),Kawasaki disease(KD)(n=4),systemic autoimmune rheumatic diseases(SARD)(n=4).The results of the study suggested that short-term elevation in particulate matter(PM)2.5 concentration was possibly associated with an increased risk of SLE and cSLE flare-ups,disease activity of AS,JIA and SARDs exacerbation.Studies demonstrated an increased risk of RA with cumulative exposure to carbon monoxide(CO),nitrogen dioxide(NO2),ozone(O3),and sulfur dioxide(SO2).Only one study demonstrated an increased risk of KD admission with elevated O3 levels.No association was found between AAV and ambient air pollution.Conclusion Air pollution is likely to be involved in the development and exacerbation of certain autoimmune diseases.At the same time,the mechanism of autoimmune diseases of ambient air pollutants should be actively studied,so as to promote the early prevention of cardiovascular diseases.