儿童期起病与成人期起病的系统性红斑狼疮临床特征差异：一项系统评价与荟萃分析。
Differences in clinical features observed between childhood-onset versus adult-onset systemic lupus erythematosus: A systematic review and meta-analysis.
作者信息
Bundhun Pravesh Kumar, Kumari Alka, Huang Feng
机构信息
Institute of Cardiovascular Diseases Department of Obstetrics and Gynecology Institute of Cardiovascular Diseases and Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P. R. China.
出版信息
Medicine (Baltimore). 2017 Sep;96(37):e8086. doi: 10.1097/MD.0000000000008086.
BACKGROUND
Systemic lupus erythematosus (SLE) affects people in childhood (childhood onset) or in adulthood (adult onset). Observational studies that have previously compared childhood-onset versus adult-onset SLE were often restricted to 1 ethnic group, or to a particular area, with a small sample size of patients. We aimed to systematically compare childhood-onset versus adult-onset SLE through a meta-analysis.
METHODS
Electronic databases were searched for relevant publications comparing childhood-onset with adult-onset SLE. Adverse clinical features were considered as the endpoints. The Newcastle Ottawa Scale (NOS) was used to assess the methodological quality of the studies and RevMan software (version 5.3) was used to carry out this analysis whereby risk ratios (RRs) and 95% confidence intervals (95% CIs) were used as the statistical parameters.
RESULTS
A total number of 10,261 participants (1560 participants with childhood-onset SLE and 8701 participants with adult-onset SLE) were enrolled. Results of this analysis showed that compared with childhood-onset SLE, pulmonary involvement was significantly higher with adult-onset SLE (RR: 1.51, 95% CI: 1.18-1.93; P = .001), whereas renal involvement was significantly higher with childhood-onset SLE (RR: 0.65, 95% CI: 0.55-0.77; P = .00001). Raynaud phenomenon and photosensitivity were significantly higher in adult-onset SLE (RR: 1.29, 95% CI: 1.04-1.60; P = .02) and (RR: 1.08, 95% CI: 1.01-1.17; P = .03), respectively. Malar rash significantly favored adult-onset SLE (RR: 0.84, 95% CI: 0.75-0.94; P = .002). Childhood-onset SLE was associated with significantly higher hemolytic anemia, thrombocytopenia, leukocytopenia, and lymphopenia. Seizure and ocular manifestations were significantly higher with childhood-onset SLE (RR: 0.57, 95% CI: 0.47-0.70; P = .00001) and (RR: 0.34, 95% CI: 0.21-0.55; P = .00001), respectively, whereas pleuritis was significantly higher with adult-onset SLE (RR: 1.45, 95% CI: 1.17-1.79; P = .0008). Vasculitis and fever were significantly higher with childhood-onset SLE (RR: 0.51, 95% CI: 0.36-0.74; P = .0004) and (RR: 0.78, 95% CI: 0.68-0.89; P = .0002) respectively.
CONCLUSION
Significant differences were observed between childhood-onset versus adult-onset SLE, showing the former to be more aggressive.
背景
系统性红斑狼疮（SLE）可在儿童期（儿童发病型）或成年期（成人发病型）发病。以往比较儿童发病型与成人发病型SLE的观察性研究往往局限于一个种族群体或特定地区，且患者样本量较小。我们旨在通过荟萃分析系统地比较儿童发病型与成人发病型SLE。
方法
检索电子数据库以查找比较儿童发病型与成人发病型SLE的相关出版物。将不良临床特征视为终点。采用纽卡斯尔渥太华量表（NOS）评估研究的方法学质量，并使用RevMan软件（5.3版）进行此分析，其中风险比（RRs）和95%置信区间（95% CIs）用作统计参数。
结果
共纳入10261名参与者（1560名儿童发病型SLE参与者和8701名成人发病型SLE参与者）。该分析结果显示，与儿童发病型SLE相比，成人发病型SLE的肺部受累显著更高（RR：1.51，95% CI：1.18 - 1.93；P = 0.001），而儿童发病型SLE的肾脏受累显著更高（RR：0.65，95% CI：0.55 - 0.77；P = 0.00001）。雷诺现象和光敏反应在成人发病型SLE中显著更高（RR：1.29，95% CI：1.04 - 1.60；P = 0.02）和（RR：1.08，95% CI：1.01 - 1.17；P = 0.03）。蝶形红斑显著更常见于成人发病型SLE（RR：0.84，95% CI：0.75 - 0.94；P = 0.002）。儿童发病型SLE与显著更高的溶血性贫血、血小板减少、白细胞减少和淋巴细胞减少相关。癫痫发作和眼部表现在儿童发病型SLE中显著更高（RR：0.57，95% CI：0.47 - 0.70；P = 0.00001）和（RR：0.34，95% CI：0.21 - 0.55；P = 0.00001），而胸膜炎在成人发病型SLE中显著更高（RR：1.45，95% CI：1.17 - 1.79；P = 0.0008）。血管炎和发热在儿童发病型SLE中显著更高（RR：0.51，95% CI：0.36 - 0.74；P = 0.0004）和（RR：0.78，95% CI：0.68 - 0.89；P = 0.0002）。
结论
儿童发病型与成人发病型SLE之间观察到显著差异，表明前者更具侵袭性。
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