Yazdany Jinoos, Pooley Nick, Langham Julia, Nicholson Lindsay, Langham Sue, Embleton Nina, Wang Xia, Desta Barnabas, Barut Volkan, Hammond Edward
Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.
Systematic Review Group, Maverex Limited, Manchester, UK.
RMD Open. 2020 Sep;6(2). doi: 10.1136/rmdopen-2020-001247.
To evaluate the risk of stroke and myocardial infarction (MI) in adult patients with systemic lupus erythematosus (SLE) through a systematic review and meta-analysis.
We searched MEDLINE and EMBASE from inception to May 2020 to identify observational studies (cohort and cross-sectional) that evaluated risk of stroke and MI in adult patients with SLE compared with the general population or healthy controls. Studies were included if they reported effect-size estimates that could be used for calculating pooled-effect estimates. Random-effects models were used to calculate pooled risk ratios (RRs) and 95% CIs for stroke and MI. Heterogeneity quantified by the I test and sensitivity analyses assessed bias.
In total, 26 studies were included in this meta-analysis: 14, 5 and 7 studies on stroke, MI and both stroke and MI, respectively. The pooled RR for ischaemic stroke was 2.18 (95% CI 1.78 to 2.67; I 75%), intracerebral haemorrhage 1.84 (95% CI 1.16 to 2.90; I 67%), subarachnoid haemorrhage 1.95 (95% CI 0.69 to 5.52; I 94%), composite stroke 2.13 (95% CI 1.73 to 2.61; I 88%) and MI 2.99 (95% CI 2.34 to 3.82; I 85%). There was no evidence for publication bias, and sensitivity analyses confirmed the robustness of the results.
Overall, patients with SLE were identified to have a twofold to threefold higher risk of stroke and MI. Future research on the interaction between known SLE-specific modifiable risk factors and risk of stroke and MI to support development of prevention and treatment strategies are needed.
CRD42018098690.
通过系统评价和荟萃分析评估成年系统性红斑狼疮（SLE）患者发生中风和心肌梗死（MI）的风险。
我们检索了从创刊至2020年5月的MEDLINE和EMBASE数据库，以识别观察性研究（队列研究和横断面研究），这些研究评估了成年SLE患者与普通人群或健康对照相比发生中风和MI的风险。如果研究报告了可用于计算合并效应估计值的效应量估计值，则纳入研究。采用随机效应模型计算中风和MI的合并风险比（RRs）及95%置信区间（CIs）。通过I²检验量化异质性，并进行敏感性分析以评估偏倚。
本荟萃分析共纳入26项研究：分别有14项、5项和7项研究涉及中风、MI以及中风和MI两者。缺血性中风的合并RR为2.18（95%CI 1.78至2.67；I² 75%），脑出血为1.84（95%CI 1.16至2.90；I² 67%），蛛网膜下腔出血为1.95（95%CI 0.69至5.52；I² 94%），复合性中风为2.13（95%CI 1.73至2.61；I² 88%），MI为2.99（95%CI 2.34至3.82；I² 85%）。没有证据表明存在发表偏倚，敏感性分析证实了结果的稳健性。
总体而言，SLE患者发生中风和MI的风险高出两到三倍。未来需要研究已知的SLE特异性可改变风险因素与中风和MI风险之间的相互作用，以支持预防和治疗策略的制定。
PROSPERO注册号：CRD42018098690。
