原文作者：HarrisHR,etal.
目的子宫内膜异位症、系统性红斑狼疮（SLE）和类风湿关节炎（RA）的发病原因均与免疫功能失调相关。SLE和RA在女性发病率高，生育和激素水平已与其发病风险增加相关。然而，仅有一项研究评估子宫内膜异位症与SLE或RA之间的时间关联。本研究目的在于探讨经腹腔镜确诊的子宫内膜异位症患者与其随后诊断SLE和RA之间的关联。
方法本研究分析了随访22年的护士健康研究数据（theNurses’HealthStudyII）（名女性）。用多元时变Cox风险模型来评估经腹腔镜证实的子宫内膜异位症与随后诊断SLE和RA之间关联的HRs和95%CIs。
结果从到，共诊断例SLE和例RA。经腹腔镜诊断的子宫内膜异位症与随后的诊断的SLE（HR=2.03；CI1.17至3.51）和RA（HR=1.41；CI1.05至1.89）相关。这种关联证实了SLE和RA的危险因素与其潜在的混杂因素；子宫切除及卵巢切除术减弱了这种关联，差异无统计学意义。不孕不育或年龄（45岁）对研究结果的影响无统计学意义。
结论研究结果表明，子宫内膜异位症与SLE和RA的风险之间存在关联。子宫内膜异位症、全子宫切除或其他与子宫内膜异位症相关的因素是否直接影响SLE和RA的发病，及其相关机制有待进一步研究。
原文摘要ObjectivesTheaetiologiesofendometriosis,systemiclupuserythematosus(SLE)andrheumatoidarthritis(RA)areallcharacterisedbyimmunedysfunction.SLEandRAoccurmoreofteninwomen,andreproductiveandhormonalfactorshavebeenshowntoberelatedtoincreasedrisk.However,onlyonepreviousstudyhasevaluatedthetemporalassociationbetweenendometriosisandSLEorRA.WesoughttoinvestigatetheassociationbetweenlaparoscopicallyconfirmedendometriosisandsubsequentlydiagnosedSLEandRA.
MethodsWeanalyseddatafromtheNurses’HealthStudyII(n=women)overa22-yearfollow-upperiod.Multivariable,time-varyingCoxproportionalhazardsmodelswereusedtocalculateHRsand95%CIsfortheassociationbetweenlaparoscopicallyconfirmedendometriosisandconfirmedincidentSLEorRA.
ResultsFromto,incidentcasesofSLEandcasesofRAwereconfirmed.LaparoscopicallyconfirmedendometriosiswassignificantlyassociatedwithsubsequentSLEdiagnosis(HR=2.03;CI1.17to3.51)andRAdiagnosis(HR=1.41;CI1.05to1.89).TheseassociationswererobusttoadjustmentforSLEorRAriskfactorsandforpotentialconfounders;however,adjustmentforhysterectomyandoophorectomyattenuatedbothrelationssuchthattheywerenolongersignificant.Nosignificantdifferencesbyinfertilitystatusorage(45years)wereobserved.
ConclusionsOurfindingssuggestanassociationbetweenendometriosisandriskofSLEandRA.Itremainstobeunderstoodwhetherandhowendometriosisitself,orhysterectomyorotherfactorsassociatedwithendometriosis,isrelatedtoriskofSLEorRA.
FROM：HarrisHR,etal.EndometriosisandtherisksofsystemiclupuserythematosusandrheumatoidarthritisintheNurses’HealthStudyII.AnnRheumDis;75:–.
