血清抗瓜氨酸化蛋白抗体和类风湿因子增加类风湿关节炎相关间质性肺病的风险：一项荟萃分析。
Serum anti-citrullinated protein antibodies and rheumatoid factor increase the risk of rheumatoid arthritis-related interstitial lung disease: a meta-analysis.
机构信息
Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
Department of Computer Science, University of California Santa Cruz, Santa Cruz, CA, 95064, USA.
出版信息
Clin Rheumatol. 2021 Nov;40(11):4533-4543. doi: 10.1007/s10067-021-05808-2. Epub 2021 Jun 29.
BACKGROUND
This meta-analysis aims to determine the association between antibodies including anti-citrullinated protein antibodies (ACPA) and rheumatoid factors (RF) and risk of rheumatoid arthritis-related interstitial lung disease (RA-ILD).
METHODS
PubMed, Embase, and Cochrane were searched up to September 13, 2020, for studies investigating the risk of RA-ILD in ACPA-positive patients. The statistical meta-analysis and sensitivity analysis were performed using the Review Manager 5.4 and Stata16.0 software, respectively.
RESULTS
Total 1 double-blind randomized controlled study and 16 observational studies, including 992 RA-ILD patients and 2223 RA-non ILD patients, met the inclusion criteria of the meta-analysis. Compared with ACPA-negative patients, positive serum ACPA increased the risk of RA-ILD (OR = 2.51; 95% CI: 1.35-4.68; P = 0.004) and serum ACPA titer was significantly correlated with risk of RA-ILD (SMD = 0.39; 95% CI: 0.17-0.62; P = 0.0006). In a region-based subgroup analysis, ACPA titer in Asian, European, and African populations was significantly related to the risk of RA-ILD, while there was no significant correlation in the Americans (SMD = - 0.03; 95% CI: - 0.89-0.83; P = 0.95), especially in the USA (SMD = 0.37; 95% CI: - 0.26-0.99; P = 0.25). In addition, serum positive RF increased the risk of RA-ILD (OR = 2.85; 95% CI: 2.19-3.71; P < 0.00001) and serum RF titer was significantly correlated with the risk of RA-ILD (SMD = 0.35; 95% CI: 0.23-0.46; P < 0.00001). However, for the analysis of RF dichotomous data, the funnel shape was asymmetric and the p value of egger test was less than 0.05, which indicated potential publication bias.
CONCLUSIONS
ACPA and RF positive patients have greater risk of RA-ILD, and RA patients positive for ACPA should be paid more attention.
KEY POINTS
• Autoantibodies ACPA and RF increase the risk of RA-ILD. • Regions may be related to RA-ILD.
背景
本荟萃分析旨在确定包括抗瓜氨酸化蛋白抗体（ACPA）和类风湿因子（RF）在内的抗体与类风湿关节炎相关间质性肺病（RA-ILD）风险之间的关联。
方法
截至 2020 年 9 月 13 日，我们在 PubMed、Embase 和 Cochrane 中检索了研究 ACPA 阳性患者发生 RA-ILD 风险的研究。使用 Review Manager 5.4 和 Stata16.0 软件分别进行统计荟萃分析和敏感性分析。
结果
共纳入 1 项双盲随机对照研究和 16 项观察性研究，包括 992 例 RA-ILD 患者和 2223 例 RA-非 ILD 患者，符合荟萃分析的纳入标准。与 ACPA 阴性患者相比，血清 ACPA 阳性增加了 RA-ILD 的风险（OR=2.51；95%CI：1.35-4.68；P=0.004），且血清 ACPA 滴度与 RA-ILD 风险显著相关（SMD=0.39；95%CI：0.17-0.62；P=0.0006）。基于区域的亚组分析中，亚洲、欧洲和非洲人群的 ACPA 滴度与 RA-ILD 风险显著相关，而美国人则无显著相关性（SMD=−0.03；95%CI：−0.89-0.83；P=0.95），特别是在美国（SMD=0.37；95%CI：−0.26-0.99；P=0.25）。此外，血清阳性 RF 增加了 RA-ILD 的风险（OR=2.85；95%CI：2.19-3.71；P<0.00001），且血清 RF 滴度与 RA-ILD 风险显著相关（SMD=0.35；95%CI：0.23-0.46；P<0.00001）。然而，对于 RF 二分类数据的分析，漏斗图形状不对称，Egger 检验的 P 值小于 0.05，表明存在潜在的发表偏倚。
结论
ACPA 和 RF 阳性患者发生 RA-ILD 的风险更高，应更加关注 ACPA 阳性的 RA 患者。
关键要点
抗体 ACPA 和 RF 增加了 RA-ILD 的风险。
区域可能与 RA-ILD 相关。
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