环状肉芽肿与 2 型糖尿病、血脂异常、自身免疫性疾病和血液系统恶性肿瘤的相关性。
Association of Granuloma Annulare With Type 2 Diabetes, Hyperlipidemia, Autoimmune Disorders, and Hematologic Malignant Neoplasms.
机构信息
Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Editorial Board, JAMA Dermatology.
出版信息
JAMA Dermatol. 2021 Jul 1;157(7):817-823. doi: 10.1001/jamadermatol.2021.1805.
IMPORTANCE
Although granuloma annulare (GA) has been associated with several other conditions, these studies have been limited by single-center designs and small sample sizes.
OBJECTIVE
To evaluate whether there is an association between GA and type 2 diabetes, hyperlipidemia, autoimmune conditions, and hematologic malignant neoplasms, using a large population-based cohort study.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study conducted between January 1, 2016, and June 30, 2019, used deidentified data from the US Optum Clinformatics Data Mart Database. A total of 5137 patients with GA were matched by age and sex with up to 10 randomly selected controls (n = 51 169) with a diagnosis of a nevus or seborrheic keratosis.
MAIN OUTCOMES AND MEASURES
Logistic regression was used to evaluate for potential associations between GA and diabetes, hyperlipidemia, autoimmune conditions, and hematologic malignant neoplasms. All analyses were adjusted for race/ethnicity, income, and educational level.
RESULTS
This study included 5137 individuals with GA (3760 women [73.2%]; mean [SD] age, 57.7 [19.0] years) and 51 169 controls (37 456 women [73.2%]; mean [SD] age, 57.7 [19.0] years). Those with GA were more likely than controls to have baseline diabetes (1086 [21.1%] vs 6780 [13.3%]; adjusted odds ratio [aOR], 1.67; 95% CI, 1.55-1.80), hyperlipidemia (1669 [32.5%] vs 14 553 [28.4%]; aOR, 1.15; 95% CI, 1.08-1.23), hypothyroidism (727 [14.2%] vs 5780 [11.3%]; aOR, 1.24; 95% CI, 1.15-1.36), and rheumatoid arthritis (62 [1.2%] vs 441 [0.9%]; aOR, 1.34; 95% CI, 1.02-1.75). Those with GA were more likely to have incident diabetes (144 [2.8%] vs 1061 [2.1%]; aOR, 1.31; 95% CI, 1.10-1.57), hypothyroidism (41 [0.8%] vs 252 [0.5%]; aOR, 1.59; 95% CI, 1.14-2.22), systemic lupus erythematosus (21 [0.4%] vs 65 [0.1%]; aOR, 3.06; 95% CI, 1.86-5.01), and rheumatoid arthritis (26 [0.5%] vs 122 [0.2%]; aOR, 2.05; 95% CI, 1.34-3.13). There was no association between GA and an increased risk of hematologic malignant neoplasms.
CONCLUSIONS AND RELEVANCE
This population-based cohort study identified associations between GA and baseline diabetes and hyperlipidemia as well as between GA and both baseline and incident autoimmune conditions. These findings suggest that diabetes and hyperlipidemia may be risk factors for the development of GA and that autoimmunity may be an important factor in the pathogenesis of GA.
背景：虽然环状肉芽肿（GA）与其他几种疾病有关，但这些研究受到单中心设计和小样本量的限制。
目的：使用大型基于人群的队列研究评估 GA 与 2 型糖尿病、高脂血症、自身免疫性疾病和血液恶性肿瘤之间是否存在关联。
设计、地点和参与者：这项回顾性队列研究于 2016 年 1 月 1 日至 2019 年 6 月 30 日进行，使用美国 Optum Clinformatics Data Mart 数据库中的匿名数据。共有 5137 例 GA 患者按年龄和性别与多达 10 名随机选择的对照（n=51169）相匹配，对照组诊断为痣或脂溢性角化病。
主要结局和测量：使用 logistic 回归评估 GA 与糖尿病、高脂血症、自身免疫性疾病和血液恶性肿瘤之间的潜在关联。所有分析均调整了种族/民族、收入和教育水平。
结果：这项研究包括 5137 名 GA 患者（3760 名女性[73.2%]；平均[SD]年龄为 57.7[19.0]岁）和 51169 名对照（37456 名女性[73.2%]；平均[SD]年龄为 57.7[19.0]岁）。与对照组相比，GA 患者更有可能患有基线糖尿病（1086 例[21.1%]比 6780 例[13.3%]；调整后的优势比[aOR]，1.67；95%置信区间[CI]，1.55-1.80）、高脂血症（1669 例[32.5%]比 14553 例[28.4%]；aOR，1.15；95%CI，1.08-1.23）、甲状腺功能减退症（727 例[14.2%]比 5780 例[11.3%]；aOR，1.24；95%CI，1.15-1.36）和类风湿关节炎（62 例[1.2%]比 441 例[0.9%]；aOR，1.34；95%CI，1.02-1.75）。GA 患者更有可能患有新发糖尿病（144 例[2.8%]比 1061 例[2.1%]；aOR，1.31；95%CI，1.10-1.57）、甲状腺功能减退症（41 例[0.8%]比 252 例[0.5%]；aOR，1.59；95%CI，1.14-2.22）、系统性红斑狼疮（21 例[0.4%]比 65 例[0.1%]；aOR，3.06；95%CI，1.86-5.01）和类风湿关节炎（26 例[0.5%]比 122 例[0.2%]；aOR，2.05；95%CI，1.34-3.13）。GA 与血液恶性肿瘤风险增加无关。
结论：这项基于人群的队列研究确定了 GA 与基线糖尿病和高脂血症之间的关联，以及 GA 与基线和新发自身免疫性疾病之间的关联。这些发现表明，糖尿病和高脂血症可能是 GA 发展的危险因素，而自身免疫可能是 GA 发病机制中的一个重要因素。
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