中国人群神经精神性狼疮危险因素的系统评价

Systematic review on the risk factors of neuropsychiatric systemic lupus erythematosus in Chinese population

目的:探讨中国人群神经精神性狼疮(NPSLE)发生的危险因素,估计其相对危险度,为预防和控制该病提供循证依据。方法:检索电子数据库PubMed、Cochrane图书馆(2012年4月)、中国知网数据库、万方数据库、重庆维普中文科技期刊数据库,所有在线数据库检索时间从建库到2012年5月31日,语种不限。利用Meta分析方法对检索到的国内外关于NPSLE发病危险因素的病例对照研究结果进行综合分析。应用ReviewManager5.1进行异质性检验,以Meta分析的Mantl-Haensel固定效应模型及Dersimonion-Laird随机效应模型合并比值比(OR值)及95%可信区间(95%CI),综合定量评价NPSLE危险因素的作用,或进行描述性分析。结果:纳入符合标准的病例对照研究文献6篇,累计NPSLE病例302例,无神经精神性表现(non-NP)的SLE病例805例。NPSLE危险因素的合并OR值及其95%CI分别为:ESR异常(3.19[1.76,5.78]),发热(3.41[2.11,5.50]),血小板减少(2.11[1.36,3.28]),抗Sm抗体阳性(2.00[1.33,3.02]),蝶形红斑(1.71[1.08,2.70]),血管炎性皮损(1.70[1.09,2.66]),C4水平异常降低(1.29[0.76,2.17]),C3水平异常降低(1.13[0.17,7.45]),浆膜炎(1.19[0.79,1.81]),抗RNP阳性(1.04[0.73,1.48]),关节炎/关节痛(1.05[0.55,2.00]),贫血(1.00[0.63,1.57]),抗SSB抗体阳性(0.94[0.55,1.62]),肾脏损伤/蛋白尿(0.92[0.46,1.87]),白细胞减少(0.87[0.56,1.33]),抗SSA抗体阳性(0.84[0.38,1.86]),抗ANA抗体阳性(0.84[0.47,1.48]),抗ds-DNA抗体阳性(0.80[0.58,1.11]),盘状红斑(0.51[0.30,0.87]),正规使用激素治疗(0.22[0.04,1.10]),正规使用免疫抑制剂治疗(0.42[0.09,2.02])。各独立研究报告项目及数据结果不尽一致。经敏感性分析部分合并结果并不稳定。结论:纳入研究质量总体较差,存在偏倚较高风险。根据现有证据,中国人群NPSLE的危险因素为ESR异常、发热、抗Sm抗体阳性、蝶形红斑、血管炎性皮损、血小板减少,盘状红斑为其保护性因素。其它因素与NPSLE关系尚不明确,需要进一步研究。

[ABSTRACT] Objective： To investigate the risk factors of neuropsychiatric systemic lupus erythematosus （NPSLE） in Chinese population, estimate the relative risk and provide evidence-based basis for preventing and controlling the disease. Methods： A literature search both inside and outside China was conducted in electronic databases, including PubMed, Cochrane Library （April 2012）, CNKI, Wanfang database and Chongqing Vip database from the databases creation to May 31, 2012. We analyzed synthetically the retrieved results of case-control study about the risk factors of morbidity of NPSLE both at home and abroad by Meta-analysis, carried out heterogeneity test by the Review Manager 5.1 software, and comprehensive quantitative evaluation of the roles of NPSLE risk factors or descriptive analysis with the pools OR values and 95% confidence intervals （95% CI）in mantl-haensel fixed effect model and Dersimonion-Laird random effect model of meta-analysis. Results： We brought 6 research literatures met the criteria into the investigation, which involved 302 NPSLE cases and 805 SLE cases without psychoneural performance. The pools OR values and 95% CI respectively were： abnormal ESR （3.19[1.76, 5.78] ）, fever （3.41 [2.11, 5.50] ）, thromboeytopenia （2.11 [1.36, 3.28] ）, anti-Sin antibody （ ＋ ） （2.00 [ 1.33, 3.02] ）, butterfly erythema （1.71 [1.08, 2.70] ）, vaseulitie skin lesion （1.70 [l.09, 2.66] ）,abnormally decreased C4 level （1.29 [ 0.76, 2.17 ] ）, abnormally decreased C3 level （1.13 [0.17, 7.45 ] ）, serositis （1.19 [0.79, 1.81] ）, anti-RNP antibody （＋） （1.04 [0.73, 1.481 ）, arthritis or arthralgia （1.05 [0.55, 2.00] ）, anemia （1.00 [0.63, 1.571 ）, anti-SSB antibody （＋） （0.94 [0.55, 1.62] ）, renal damage/albuminuria （0.92 [0.46, 1.87] ）, leukoeytopenia （0.87 [0.56, 1.33] ）, anti-SSA antibody （＋） （0.84 [0.38, 1.86] ）, ant-ANA antibody （＋） （0.84 [0.47, 1.48] ）, anti-ds-DNA antibody （＋） （0.80 [0.58, 1.11 ] ）, discoid erythema （0.51 [0.30, 0.87] ）, regular therapy of prednisone （0.22 [0.04, 1.10] ） and regular therapy of immunosuppressive drugs （0.42 [0.09, 2.02] ）. But each independent research report project and data results were not accordance, and combined results were not stable by the sensitivity analysis. Conclusion： The whole eligible studies level is low, there is the risk of higher bias. According to the available evidence the risk factors related to the incidence of NPSLE in Chinese people are abnormal ESR, fever, positive anti-Sm antibody, butterfly erythema, vasculitic skin lesion, thrombocytopenia, and discoid erythema are the protective factors, the relationship between other factors and NPSLE is not clear, needs further study.