免疫球蛋白 G（IgG）抗心磷脂抗体与复发性心血管事件。系统评价和贝叶斯荟萃回归分析。

Immunoglobulin G (IgG) anticardiolipin antibodies and recurrent cardiovascular events. A systematic review and Bayesian meta-regression analysis.

机构信息

I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.

Division of Allergy and Clinical Immunology, Department of Medicine, University of Salerno, Salerno, Italy.

出版信息

Autoimmun Rev. 2019 May;18(5):519-525. doi: 10.1016/j.autrev.2019.03.005. Epub 2019 Mar 4.

DOI:10.1016/j.autrev.2019.03.005

PMID:30844560

Abstract

BACKGROUND

Anticardiolipin antibodies of the immunoglobulin G isotype (IgG aCL) have been suggested as risk factor for arterial and venous thrombosis. No conclusive data in patients with coronary artery disease (CAD) do exist. We investigate the risk of recurrent CAD according to the presence of IgG aCL.

METHODS

We performed a systematic review and meta-analysis to evaluate the risk of recurrent major adverse cardiac events (MACE) associated with the presence of IgG aCL in patients with CAD. MEDLINE and Cochrane databases were searched. We conducted a meta-analysis of the relative risk (RR) both at 12 and 24 months.

RESULTS

We included 11 eligible studies with a total of 2425 patients, 283 IgG aCL+ and 2142 IgG aCL-. The prevalence of IgG aCL+ ranged from 6.1% to 43.3%. A total of 341 cardiac events were reported: 71 (25.1%) in IgG aCL+ and 270 (12.6%) in IgG aCL- patients. We found an increased risk of recurrent MACE in patients with high IgG aCL both at 12 (RR 2.17, 2.5-97.5%CI, 1.54-3.00) and 24 months (RR 2.11, 2.5-97.5%CI, 1.62-2.66). This association was even stronger in patients with juvenile CAD (i.e. <50 years) at both 12 (RR 3.21, 2.5-97.5%CI, 1.74-5.41) and 24 months (RR 3.24, 2.5-97.5%CI, 1.84-5.21).

CONCLUSION

Patients with CAD and elevated IgG aCL have a doubled risk of recurrent MACE at 12 and 24 months. The presence of aCL should be suspected in patients with recurrent CAD events or in patients with juvenile CAD.

摘要

背景

免疫球蛋白 G 型抗心磷脂抗体（IgG aCL）已被认为是动脉和静脉血栓形成的危险因素。但在冠心病（CAD）患者中尚无明确结论。我们根据 IgG aCL 的存在来研究复发性 CAD 的风险。

方法

我们进行了系统评价和荟萃分析，以评估 CAD 患者中 IgG aCL 存在与复发性主要不良心脏事件（MACE）相关的风险。检索了 MEDLINE 和 Cochrane 数据库。我们对 12 个月和 24 个月时的相对风险（RR）进行了荟萃分析。

结果

我们纳入了 11 项符合条件的研究，共 2425 例患者，283 例 IgG aCL+，2142 例 IgG aCL-。IgG aCL+的患病率为 6.1%至 43.3%。共报告了 341 例心脏事件：IgG aCL+患者 71 例（25.1%），IgG aCL-患者 270 例（12.6%）。我们发现 IgG aCL 水平较高的患者复发性 MACE 的风险增加，12 个月时 RR 为 2.17（95%CI：1.54-3.00），24 个月时 RR 为 2.11（95%CI：1.62-2.66）。在青少年 CAD（即<50 岁）患者中，这种关联在 12 个月时 RR 为 3.21（95%CI：1.74-5.41）和 24 个月时 RR 为 3.24（95%CI：1.84-5.21）时更为明显。