类风湿关节炎合并间质性肺疾病危险因素的Meta分析

Meta-analysis of risk factors for rheumatoid arthritis complicated with interstitial pulmonary disease

目的采用Meta分析方法,探讨RA患者合并间质性肺疾病危险因素,以期为临床实践提供可靠的参考和依据。方法使用计算机检索中国知网、维普、万方、中国生物医学文献数据库、EMbase、PubMed和Cochrane Library数据库,以获取关于RA合并间质性肺疾病危险因素的队列研究和病例对照研究方面的文献,检索时间从建库起至2022年12月31日止。由2名研究者独立进行文献筛选、信息提取以及最终的质量评价。采用RevMan 5.3软件对提取出的数据进行分析。结果本次研究共纳入了31篇文献,共计26747例患者,其中RA合并间质性肺疾病患者4799例(17.94%),共得出12个危险因素,分别为:高龄[OR值(95%CI)=1.07(1.04,1.09),P<0.001]、高发病年龄[OR值(95%CI)=2.11(1.17,3.82),P=0.010]、男性[OR值(95%CI)=1.95(1.34,2.84),P<0.001]、病程长[OR值(95%CI)=1.10(1.08,1.13),P<0.001]、吸烟[OR值(95%CI)=2.47(1.57,4.04),P<0.001]、高度疾病活动度[OR值(95%CI)=1.75(1.21,2.54),P=0.003]、咳嗽[OR值(95%CI)=6.10(2.40,15.52),P<0.001]、肺一氧化碳弥散量降低[OR值(95%CI)=0.93(0.89,0.96),P<0.001]、高滴度抗CCP抗体[OR值(95%CI)=1.14(1.03,1.26),P=0.010]、高滴度RF[OR值(95%CI)=2.37(1.70,3.29),P<0.001]、较高的免疫球蛋白A[OR值(95%CI)=1.26(1.09,1.46),P=0.002]和糖类抗原125升高[OR值(95%CI)=3.66(1.81,7.41),P<0.001]。结论现有证据显示,高龄、高发病年龄、男性、病程长、吸烟、高度疾病活动度、咳嗽、肺一氧化碳弥散量降低、高滴度抗CCP抗体、高滴度的RF、较高的免疫球蛋白A和糖类抗原125升高是RA患者发生间质性肺疾病的主要危险因素,而雷诺现象和糖类抗原153为RA合并间质性肺疾病的危险因素的证据不充分,还需要开展更多高质量的前瞻性队列研究。

Objective A meta-analysis was conducted to investigate the risk factors of interstitial lung disease in patients with RA to provide a reliable reference for clinical practice.Methods Publications of the China Knowledge Network,Vipshop,Wanfang,China Biomedical Literature Database,EMbase,PubMed,and Cochrane Library databases were searched to obtain literature on cohort studies and case-control studies for risk factors for RA complicated with interstitial lung disease from the time of database creation until December 31,2022.Literature screening,information extraction,and final quality evaluation were performed independently by two investigators.The extracted data were analyzed using RevMan 5.3 software.Results A total of 31 studies with a total of 26747 patients were included in this study,of which 4799 patients(17.94%)were patients with RA complicated with interstitial lung disease.A total of 12 risk factors were obtained included:advanced age[OR(95%CI)=1.07(1.04,1.09),P<0.001],high age at onset[OR(95%CI)=2.11(1.17,3.82),P=0.010],male[OR(95%CI)=1.95(1.34,2.84),P<0.001],long duration of disease[OR(95%CI)=1.10(1.08,1.13),P<0.001],smoking[OR(95%CI)=2.47(1.57,4.04),P<0.001],high disease activity[OR(95%CI)=(1.21,2.54),P=0.003],cough[OR(95%CI)=6.10(2.40,15.52),P<0.001],decreased pulmonary carbon monoxide diffusing capacity[OR(95%CI)=0.93(0.89,0.96),P<0.001],and high titer anti-CCP antibody[OR(95%CI)=1.14(1.03,1.26),P=0.010],high titer RF[OR(95%CI)=2.37(1.70,3.29),P<0.001],high level of immunoglobulin A[OR(95%CI)=1.26(1.09,1.46),P=0.002]and high level of glycoprotein antigen 125[OR(95%CI)=3.66(1.81,7.41),P<0.001].Conclusion The existing evidence have shown that advanced age,high age at onset,male,long disease duration,smoking,high disease activity,cough,decreased pulmonary carbon monoxide diffusing capacity,high titer anti-CCP antibody and RF,high level of immunoglobulin A and high level of glycoprotein antigen 125 are the main risk factors for interstitial lung disease in patients with rheumatoid arthritis.However,the evidence of Raynaud's phenomenon and tumor marker CA153 as risk factors for RA complicated with interstitial lung disease is not strong,and further high-quality prospective cohort studies are needed.