爱美之心人皆有之，各种美容手术的广告随处可见。一个朋友问我，都知道染发剂能诱发自身免疫病，但是隆胸手术是否会导致风湿病的发生呢？
关于这个话题其实早有争议。隆胸手术的植入物或称植入假体是含硅的材料。1964年有报道称硅酮隆乳后引发系统性红斑狼疮、硬皮病、皮肌炎、风湿性关节炎等自身免疫病。1992年，乳房硅胶移植物在美国美容市场退出，这反映了大众对其风险的担忧。但1995年美国风湿病学会声明，硅胶假体隆乳不会引发结缔组织疾病。1999年英国科学院医学研究所明确提出隆乳不会导致免疫性疾病。2006年，这个“胸器”再次被批准使用。最近的一项关于硅胶植入后的荟萃研究再次引发人们对该问题的讨论，虽然没有明确的结论，类风湿、干燥综合征和雷诺综合征发生的风险似乎在增加。
不管如何，风湿科患者在就诊时应当提供是否有假体植入的手术史。
Women with Silicone Gel Breast Implants
Ann Intern Med. 2016 Feb 2;164(3):164-75. doi: 10.7326/M15-1169. Epub 2015 Nov 10.
Long-Term Health Outcomes in Women With Silicone Gel Breast Implants:
A Systematic Review.
Balk EM, Earley A, Avendano EA, Raman G.
BACKGROUND:
Silicone gel breast implants were removed from the U.S. market for cosmetic use in 1992 owing to safety concerns. They were reintroduced in 2006, with a call for improved surveillance of clinical outcomes.
PURPOSE:
To systematically review the literature regarding specific long-term health outcomes in women with silicone gel breast implants, including cancer; connective tissue, rheumatologic, and autoimmune diseases; neurologic diseases; reproductive issues, including lactation; offspring issues; and mental health issues (depression and suicide).
DATA SOURCES:
MEDLINE, EMBASE, and Ovid Healthstar (inception through 30 June 2015), and the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the first quarter of 2015).
STUDY SELECTION:
4 researchers double-screened articles for longitudinal studies that compared women with and without breast implants and reported long-term health outcomes of interest.
DATA EXTRACTION:
4 researchers extracted data on participant and implant characteristics, analytic methods, and results.
DATA SYNTHESIS:
32 studies (in 58 publications) met eligibility criteria. Random-effects model meta-analyses of effect sizes were conducted when feasible. For most outcomes, there was at most only a single adequately adjusted study, which usually found no significant associations. There were possible associations with decreased risk for primary breast and endometrial cancers and increased risks for lung cancer, rheumatoid arthritis, Sj?gren syndrome, and Raynaud syndrome. Evidence on breast implants and other outcomes either was limited or did not exist.
LIMITATION:
The evidence was most frequently not specific to silicone gel implants, and studies were rarely adequately adjusted for potential confounders.
CONCLUSION:
The evidence remains inconclusive about any association between silicone gel implants and long-term health outcomes. Better evidence is needed from existing large studies, which can be reanalyzed to clarify the strength of associations between silicone gel implants and health outcomes.