摘 要

背景：

        环境因素在类风湿关节炎(RA)病因中发挥重要作用，但是有关不同职业的患病风险尚不清楚。我们探讨了职业与抗瓜氨酸化蛋白抗体(ACPA)阳性RA和ACPA阴性RA的相关性。

方法：

        我们分析了来自瑞典人群EIRA的病例对照研究3522例患者和5580例对照。通过问卷调查获得工作经历和生活方式的相关信息。留取血样进行血清学分析。采用无条件logistic回归法计算纳入研究前职业的OR值。对已知的环境暴露和生活方式因素予以校正后进行分析，包括吸烟、饮酒、体重指数(BMI)和教育情况。

结果：

        在男性中，瓦工、混凝土工(OR值：2.9，95%可信区间：1.4-5.7)，材料处理操作者(OR值：2.4，95%可信区间：1.3-4.4)和电气和电子工(OR值：2.1，95%可信区间：1.1-3.8)，患ACPA阳性RA的风险增加。对于ACPA阴性RA患者，瓦工、混凝土工(OR值：2.4，95%可信区间：1.0-5.7)和电气和电子工(OR值：2.6，95%可信区间：1.3-5.0)风险增加。在女性中，助理护士和服务员患ACPA阳性RA的风险轻度增加(OR值：1.3，95%可信区间：1.1-1.6)。没有职业与女性ACPA阴性RA相关。

结论：

        在校正已知的混杂因素后，与潜在有害的空气剂相关的主要职业与ACPA阳性或ACPA阴性RA的风险增加有关。

原 文

Abstract

        OBJECTIVE:Environmentalfactors are of importance for the etiology ofrheumatoidarthritis(RA), but much remains unknown concerning the contributionsfrom distinct occupational hazards. We explored the association betweenoccupation and the risk of anti-citrullinated protein antibody (ACPA) + RA orACPA- RA.

        METHODS:We analyzed 3,522 cases and 5,580 controls from the Swedishpopulation-based EIRA case-control study. A questionnaire was used to obtaininformation on work history and lifestyle factors. Blood samples were taken forserologic analyses. Unconditional logistic regression was used to calculate theodds ratio (OR) of RA associated with the last occupation before studyinclusion. Analyses were performed with adjustments for known environmentalexposures and lifestyle factors, including pack years of cigarette smoking,alcohol use, body mass index (BMI) and education.

        RESULTS:Among men, bricklayersand concrete workers (OR: 2.9, 95% CI: 1.4-5.7), material handling operators(OR: 2.4, 95% CI: 1.3-4.4) and electrical and electronics workers (OR: 2.1, 95%CI: 1.1-3.8), had an increased risk of ACPA+ RA. For ACPA- RA, bricklayers and concreteworkers (OR: 2.4, 95% CI: 1.0-5.7) and electrical and electronics workers (OR:2.6, 95% CI: 1.3-5.0) had an increased risk. Among women, assistant nurses andattendants had a moderately increased risk of ACPA+ RA (OR: 1.3, 95% CI:1.1-1.6). No occupations were significantly associated to ACPA- RA among women.

        CONCLUSION:Mainlyoccupations related to potential noxious airborne agents were associated withan increased risk of ACPA+ or ACPA- RA, after adjustments for previously knownconfounders.

        引自：Ilar A, Alfredsson L, Wiebert P, et al.Occupation andRisk of DevelopingRheumatoid Arthritis: Results From a Population-BasedCase-Control Study. ArthritisCareRes (Hoboken).2017 Aug 10. doi: 10.1002/acr.23321. [Epubahead of print]