Environmental exposure can induce systemic lupus erythematosus: a research express based on the results of the Jiangsu population survey

This study investigated the living environment of 2231 hospitalized patients with systemic lupus erythematosus (h-SLE) in 13 cities in Jiangsu Province from 1999 to 2009
.

Analysis shows that environmental exposure can induce systemic lupus erythematosus.
Nitrogen oxides (NOx) in the air and drinking water may be one of the important susceptibility factors for systemic lupus erythematosus; environmental exposure not only increases the prevalence, but also increases the patient’s Mortality
.

The cause of systemic lupus erythematosus (SLE) is complex and is related to multiple factors such as heredity, sex hormones, and environment
.

Among environmental factors, in addition to viral and bacterial infections, air pollutants (such as NO2, SO2, CO, O3, etc.
) and drinking water pollution are also considered as potential risk factors for the onset of SLE
.

However, because it is difficult to eliminate the interference factors related to the patient’s personal living environment, and the lack of multi-center, large-sample studies to demonstrate, we have not been able to clearly understand the exact correlation between air and drinking water pollution and SLE, which also limits the correlation.
The formulation of preventive measures
.

In order to assess the impact of environmental exposure on SLE, Nanjing scholar Chen Jiaqi and others conducted a cohort study in Jiangsu Province to examine the living environment (including air and drinking water pollution, population density, economic development, etc.
) and hospitalized SLE (h-SLE) The relationship between prevalence and mortality
.

The research was published in the journal Sci Rep.
(impact factor 4.
373) on September 20
.

Research methods The study included 2231 h-SLE patients registered in the Jiangsu Provincial Database from 1999 to 2009
.

Investigate the NO2 concentration, night light data, and chemical type of drinking water in the patient's area
.

Measure the economic development level of the area with night light data
.

Use BOX-COX transformation, Shapiro-Wilk test method, single factor analysis and other data processing methods to analyze the data (for data analysis, please refer to the original text)
.

The results of the study showed that environmental exposure can induce h-SLE.
The survey showed that there are regional differences in the prevalence of h-SLE in various regions
.

The prevalence rate of h-SLE was the highest in Zhenjiang Runzhou District, 26.
6 cases per 100,000 people, and the prevalence rate in Sihong County of Suqian was the lowest, at 0.
11 cases per 100,000 people, the ratio of the two was as high as 240 times
.

It is speculated that environmental exposure is an important cause of SLE
.

The normalization analysis also verified this view (R2=0.
62)
.

Runzhou District, Jingkou District, and Dantu District are three areas with a high prevalence rate (more than 10 cases per 100,000 people).
They are all located in Zhenjiang on the south bank of the Yangtze River.
There are a large number of chemical companies gathered here, so the waste gas emitted by chemical factories is concentrated.
It may also be involved in the pathogenesis of SLE (Figure 1)
.


Figure 1 Population and distribution of h-SLE patients in Jiangsu Province Air and drinking water pollution increased h-SLE prevalence The distribution of NO2 air concentration monitored by atmospheric remote sensing showed that areas with higher NO2 concentrations had a higher prevalence of h-SLE
.

The three high-prevalence areas of Runzhou District, Jingkou District and Dantu District are located in the chemical industry emission concentration area (Figure 2)
.

Figure 2 Exhaust emissions and the distribution of h-SLE patients In short, the research data supports that SLE is related to the centralized emissions of chemical plants or vehicle emissions
.

At the same time, investigating the two drinking water sources of surface water and ground water found that the prevalence of h‑SLE is positively correlated with drinking water pollution
.

Environmental pollution increases h‑SLE mortality The clinical characteristics and mortality of patients surveyed revealed that pericarditis and proteinuria are positively correlated with the prevalence of h‑SLE; and environmental pollution not only leads to the high prevalence of h‑SLE, but also causes death The rate increases
.

Considering that nitrogen oxide (NOx) is the only common substance in air and water pollution, and whether it is air or water pollution, areas with higher NOx concentrations have a high proportion of patients with pericarditis and proteinuria.
NOx in drinking water pollution may be one of the main environmental factors that induce SLE
.

Research conclusions Research shows that there are regional differences in the prevalence of h-SLE patients, and the ratio of the highest to the lowest prevalence is 240 times
.

At the same time, the prevalence of h-SLE patients is higher in areas with severe air and drinking water pollution
.

This suggests that the onset of SLE is related to the living environment, especially the concentrated discharge of air pollution and the substandard drinking water quality
.

NOx, a common substance in air and drinking water pollution, may be one of the main environmental factors that induce SLE
.

However, the mechanism of NOx involved in the pathogenesis of SLE is still unclear.
It is speculated that long-term exposure to NOx may cause inflammation and increase the release of inflammatory factors (such as IL-6)
.

Previous studies have stated that economic development, economic income, and mental stress may be related to the onset of SLE
.

However, this study uses night light data to reflect regional economic development and living standards.
The data shows that there is no significant correlation between the prevalence of h-SLE and night light data in various regions
.

In order to further confirm the relationship between economic level and living standard and h-SLE prevalence, the study analyzed the differences in h-SLE patients between rural and urban areas and found that, except for age differences (35.
99±12.
79&34.
41±12.
34, p=0.
0063) In addition, there was no other significant difference in h-SLE prevalence between urban and rural areas
.

References: Chen J, Qu W, Sun L, et al.
The relationship of polluted air and drinking water sources with the prevalence of systemic lupus erythematosus: a provincial population-based study[J].
Sci Rep.
2021 Sep 20;11 (1):18591.