炎症与主动脉僵硬度：炎症性肠病患者的个体参与者数据荟萃分析。
Inflammation and Aortic Stiffness: An Individual Participant Data Meta-Analysis in Patients With Inflammatory Bowel Disease.
机构信息
Department of Clinical and Experimental Medicine, School of Nephrology, University of Catania, Italy
Nephrology and Dialysis Unit, "St. Giovanni di Dio" Hospital, Agrigento, Italy.
出版信息
J Am Heart Assoc. 2017 Oct 10;6(10):e007003. doi: 10.1161/JAHA.117.007003.
BACKGROUND
The recent finding that aortic pulse wave velocity (aPWV) is increased in patients with inflammatory bowel disease may explain why the cardiovascular risk is increased despite the low prevalence of traditional cardiovascular risk factors. We aimed to test whether inflammation is associated with aortic stiffening in this setting after adjustment for major confounders and to perform subgroup analyses.
METHODS AND RESULTS
A systematic literature search for aPWV in inflammatory bowel disease was performed using PubMed, Scopus, Web of Science, and Google Scholar databases (last accessed May 7, 2017). Inclusion criterion was peer-reviewed publications on clinical studies reporting original data. This study followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data 2015 guidelines. Data were provided for 4 cohorts in 3 countries (151 participants with ulcerative colitis, 159 with Crohn's disease, and 227 control patients). Using aPWV, cohort-specific scores were calculated after log-transform and combined in meta-analysis to form pooled effects using a random-effects model. Compared with controls, aPWV was increased in patients with Crohn's disease (mean difference 0.78 score; 95% confidence interval, 0.56-1.00 score [<0.001]) and ulcerative colitis (mean difference 0.75 score; 95% confidence interval, 0.52-0.97 score [<0.001]). In an outlier-robust multivariate linear regression model adjusted for prespecified confounders, aPWV was associated with disease duration (years, β=0.05 score; 95% confidence interval, 0.02-0.08 score [<0.001]) and white blood cell count (billion cells/L, β=0.07 score; 95% confidence interval, 0.02-0.11 score [=0.002]) but not with markers of acute inflammation (C-reactive protein and erythrocyte sedimentation rate), cardiovascular risk factors, and therapy.
CONCLUSIONS
The increased aPWV reported in patients with inflammatory bowel disease is associated with inflammation.
CLINICAL TRIAL REGISTRATION
URL: http://www.crd.york.ac.uk. Unique identifier: PROSPERO 2016: CRD42016053070.
背景
最近的研究发现，炎症性肠病患者的主动脉脉搏波速度（aPWV）增加，这可能解释了为什么尽管传统心血管危险因素的患病率较低，但心血管风险仍然增加。我们旨在检验在调整了主要混杂因素后，炎症是否与该环境下的主动脉僵硬度增加有关，并进行亚组分析。
方法和结果
使用 PubMed、Scopus、Web of Science 和 Google Scholar 数据库（最后一次访问时间为 2017 年 5 月 7 日）对炎症性肠病的 aPWV 进行了系统的文献检索。纳入标准为报道原始数据的临床研究的同行评审出版物。本研究遵循 2015 年个体参与者数据系统评价和荟萃分析的首选报告项目指南。来自 3 个国家的 4 个队列的数据（151 例溃疡性结肠炎患者、159 例克罗恩病患者和 227 例对照患者）提供了数据。使用 aPWV，在对数转换后计算队列特异性分数，并在荟萃分析中组合，使用随机效应模型形成汇总效应。与对照组相比，克罗恩病患者的 aPWV 升高（平均差异 0.78 分；95%置信区间，0.56-1.00 分[<0.001]）和溃疡性结肠炎患者（平均差异 0.75 分；95%置信区间，0.52-0.97 分[<0.001]）。在调整了预先指定的混杂因素的稳健多元线性回归模型中，aPWV 与疾病持续时间（年，β=0.05 分；95%置信区间，0.02-0.08 分[<0.001]）和白细胞计数（十亿细胞/L，β=0.07 分；95%置信区间，0.02-0.11 分[=0.002]）相关，但与急性炎症标志物（C 反应蛋白和红细胞沉降率）、心血管危险因素和治疗无关。
结论
炎症性肠病患者报告的 aPWV 升高与炎症有关。
临床试验注册
网址：http://www.crd.york.ac.uk。独特标识符：PROSPERO 2016：CRD42016053070。
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