系统性红斑狼疮患者发生肺动脉高压危险因素的Meta分析

Risk Factors for Pulmonary Hypertension in Patients With Systemic Lupus Erythematosus:A Meta-analysis

目的探讨系统性红斑狼疮(SLE)患者发生肺动脉高压(PAH)的危险因素。方法通过计算机检索和文献追溯的方法,检索Pub Med、中国知网和万方数据知识服务平台中SLE患者发生PAH危险因素的相关文献,时间限定为建库至2015年1月。两名研究员独立进行文献筛选并提取文献资料,包括第一作者、发表时间、病例收集时间、样本量、研究因素,采用纽卡斯尔-渥太华量表(NOS)对纳入文献进行质量评价。依据比值比(OR值)及其95%CI评估各临床表现及实验室指标与SLE患者发生PAH的关系。结果纳入15篇病例对照研究,NOS评分均≥7分,文献总体质量较高。出现雷诺现象的SLE患者发生PAH的风险高于未出现雷诺现象者〔OR=3.96,95%CI(2.94,5.34),P<0.05〕。有无皮肤血管炎的SLE患者发生PAH的风险比较,差异无统计学意义(P>0.05)。抗核糖核蛋白(RNP)抗体阳性的SLE患者发生PAH的风险高于抗RNP抗体阴性者〔OR=3.32,95%CI(2.37,4.66),P<0.05〕。抗心磷脂(ACL)-IgG抗体阳性的SLE患者发生PAH的风险高于抗ACL-IgG抗体阴性者〔OR=3.36,95%CI(2.37,4.76),P<0.05〕。合并浆膜炎的SLE患者发生PAH的风险高于无浆膜炎者〔OR=2.63,95%CI(1.50,4.59),P<0.05〕。合并肺间质病变的SLE患者发生PAH的风险高于无肺间质病变者〔OR=4.65,95%CI(3.13,6.88),P<0.05〕。结论雷诺现象、抗RNP抗体阳性、抗ACL-IgG抗体阳性、浆膜炎、肺间质病变是SLE患者发生PAH的危险因素。

Objective To investigate the risk factors for pulmonary arterial hypertension （PAH） in patients with systemic lupus erythematosus （SLE）. Methods By computer - based retrieval and literature retrospect, we searched for literature about the risk factors for PAH in SLE patients from PubMed, CNKI and Wanfang Data with a time range from database establishment to January 2015. Two researchers independently conducted literature screening and extracted data including the first author, publishing time, time for case collection, volume of samples and research factors. Quality evaluation on tile included literature was conducted by NOS. According to OR value and its 95% CI, the correlation between each clinical manifestation and laboratory index and PAH in SLE patients was evaluated. Results There were 15 case - control studies included; their NOS scores were all 〉17, and their overall quality were good. SLE patients combined with Raynaud＇s phenomenon were higher than patients without Raynaud＇s phenomenon in the risk for PAH [ OR = 3.96, 95% CI （2.94, 5.34）, P 〈 0. 05 ]. There was no significant difference between SLE patients with or without cutaneous vasculitis in the risk fur PAH （ P 〉 0. 05 ）. SLE patients with positive anti - RNP antibody were higher than patients with negative anti - RNP antibody in the risk for PAH [ OR = 3.32, 95% CI （2. 37, 4. 66） , P 〈0. 05 ]. SLE patients with positive anti ACL-IgG antibody were higher than patients with negative anti ACL-IgG antibody in the risk for PAH [ OR = 3.36, 95% CI （2. 37, 4. 76）, P 〈 0. 05 1. SLE patients combined with serositis were higher than SLE patients without serositis in the risk for PAH [ OR =2.63, 95% CI （ 1.50, 4.59）, P 〈0. 05）. SLE patients combined with interstitial lung disease were higher than patients without interstitial lung disease in the risk for PAH OR = 4.65, 95% CI （ 3.13, 6. 88 ）, P 〈 0. 05 ]. Conclusion Raynaud＇ s phenomenon, positive anti - RNP antibody, positive anti ACL-IgG antibody, serositis and interstitial lung disease are risk factors for PAH in SLE patients.