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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2867

摘要内容如下：

背景

未确定意义的单克隆丙种球蛋白病（MGUS）是多发性骨髓瘤（MM）和相关疾病的前兆。在先前基于登记的回顾性研究中，自身免疫性疾病与MGUS相关。然而，这些研究不是基于筛选的人群，因此容易产生确定偏差。

客观

研究MGUS是否与自身免疫性疾病相关。

设计

ISTOPMM（冰岛筛查、治疗或预防多发性骨髓瘤）中的一项横断面研究，一项前瞻性、基于人群的MGUS筛查研究

设置

冰岛40岁及以上的成年人口。

病人

75422人接受了MGUS筛查。

测量

在患有或未患有自身免疫性疾病的人群中，MGUS患病率（PRS）的泊松回归，对年龄和性别进行了调整。

结果

共有10818名参与者患有自身免疫性疾病，其中599人患有MGUS（61人有既往临床诊断，538人在研究筛查或评估中确诊）。自身免疫性疾病的诊断与MGUS无关（PR，1.05[95%CI，0.97-1.15]）。然而，自身免疫性疾病的诊断与先前临床诊断的MGUS相关（PR，2.11[CI，1.64至2.70]）。

局限性

注册数据用于收集自身免疫性疾病的信息，冰岛人群的同质性可能会限制这些结果的可推广性。

结论

在系统筛查的人群中，该研究未发现自身免疫性疾病与MGUS之间存在关联。以前的研究没有在系统筛选的人群中进行，可能会受到确定偏差的影响。研究结果表明，对自身免疫性疾病患者进行常规MGUS筛查的建议可能是不合理的。

主要资金来源

国际骨髓瘤基金会和欧洲研究理事会。

英文原文如下：

Abstracts

BACKGROUND  Monoclonal gammopathy of undetermined significance (MGUS) is a precursor of multiple myeloma (MM) and related conditions. In previous registry-based, retrospective studies, autoimmune diseases have been associated with MGUS. However, these studies were not based on a screened population and are therefore prone to ascertainment bias.

OBJECTIVE  To examine whether MGUS is associated with autoimmune diseases.

DESIGN  A cross-sectional study within iStopMM (Iceland Screens, Treats, or Prevents MM), a prospective, population-based screening study of MGUS.

SETTING  Icelandic population of adults aged 40 years or older.

PATIENTS  75 422 persons screened for MGUS.

MEASUREMENTS  Poisson regression for prevalence ratios (PRs) of MGUS among persons with or without an autoimmune disease, adjusted for age and sex.

RESULTS  A total of 10 818 participants had an autoimmune disorder, of whom 599 had MGUS (61 with a prior clinical diagnosis and 538 diagnosed at study screening or evaluation). A diagnosis of an autoimmune disease was not associated with MGUS (PR, 1.05 [95% CI, 0.97 to 1.15]). However, autoimmune disease diagnoses were associated with a prior clinical diagnosis of MGUS (PR, 2.11 [CI, 1.64 to 2.70]).

LIMITATION  Registry data were used to gather information on autoimmune diseases, and the homogeneity of the Icelandic population may limit the generalizability of these results.

CONCLUSION  The study did not find an association between autoimmune disease and MGUS in a systematically screened population. Previous studies not done in systematically screened populations have likely been subject to ascertainment bias. The findings indicate that recommendations to routinely screen patients with autoimmune disease for MGUS may not be warranted.

PRIMARY FUNDING SOURCE  The International Myeloma Foundation and the European Research Council.

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