Department of Internal Medicine, Greenfield Family Medicine, Baystate Franklin Medical Center, 48 Sanderson Street, Greenfield, MA, USA.
Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Clin Rheumatol. 2018 Oct;37(10):2825-2832. doi: 10.1007/s10067-017-3926-9. Epub 2017 Nov 25.
Chronic inflammation from autoimmune diseases has shown to be a risk factor for atherosclerosis, subsequently leading to cardiovascular disease. Endothelial dysfunction is the early pathogenesis of atherosclerosis in chronic inflammation, but the risk of atherosclerosis in sarcoidosis is less well defined. This meta-analysis aimed to explore the association of subclinical atherosclerosis and arterial stiffness in sarcoidosis. A comprehensive search of the MEDLINE and EMBASE databases was performed from date of inception through August 2017. The inclusion criterion was observational studies evaluating the association between sarcoidosis, subclinical atherosclerosis, and arterial stiffness by measuring pulse wave velocity (PWV). Definitions of sarcoidosis and methods to assess PWV were recorded for each study. The pooled standardized mean difference (SMD) of PWV and 95% confidence interval (CI) was calculated using a random-effects meta-analysis. The between-study heterogeneity of effect size was quantified using the Q statistic and I . Data were extracted from five observational studies involving 499 subjects. Pooled result demonstrated a significant increase in PWV in patients who have sarcoidosis compared with controls (SMD = 0.57 m/s; 95% CI 0.21-0.92, p value = 0.002, I = 75%, P < 0.01). After excluding studies with low or moderate quality, there was an increase in PWV in sarcoidosis compared with controls (SMD = 0.29 m/s; 95% CI 0.00-0.57, p value = 0.05, I = 55%, P = 0.08). Our study suggests that sarcoidosis is associated with increased arterial stiffness and therefore at risk of subclinical atherosclerosis. Prospective study is required to investigate the association of subclinical atherosclerosis causing overt cardiovascular disease in patients with sarcoidosis.
自身免疫性疾病引起的慢性炎症已被证明是动脉粥样硬化的一个危险因素,进而导致心血管疾病。内皮功能障碍是慢性炎症中动脉粥样硬化的早期发病机制,但结节病的动脉粥样硬化风险定义尚不明确。本荟萃分析旨在探讨结节病患者亚临床动脉粥样硬化和动脉僵硬度的相关性。从建库日期到 2017 年 8 月,我们对 MEDLINE 和 EMBASE 数据库进行了全面检索。纳入标准为观察性研究,通过测量脉搏波速度(PWV)评估结节病、亚临床动脉粥样硬化和动脉僵硬度之间的相关性。记录了每项研究中结节病的定义和 PWV 评估方法。使用随机效应荟萃分析计算 PWV 的标准化均数差(SMD)及其 95%置信区间(CI)。使用 Q 统计量和 I 来量化效应大小的研究间异质性。共纳入了五项涉及 499 例患者的观察性研究。汇总结果显示,与对照组相比,患有结节病的患者的 PWV 显著增加(SMD=0.57 m/s;95%CI 0.21-0.92,p 值=0.002,I =75%,P <0.01)。排除低质量或中等质量的研究后,与对照组相比,结节病患者的 PWV 仍有增加(SMD=0.29 m/s;95%CI 0.00-0.57,p 值=0.05,I =55%,P =0.08)。我们的研究表明,结节病与动脉僵硬度增加有关,因此存在亚临床动脉粥样硬化的风险。需要进行前瞻性研究以探讨结节病患者亚临床动脉粥样硬化导致明显心血管疾病的相关性。