Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, 20 Yuhuangding East Road, Yantai, 264200, Shandong, China.
Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, 20 Yuhuangding East Road, Yantai, 264200, Shandong, China.
Respir Res. 2021 Oct 11;22(1):264. doi: 10.1186/s12931-021-01856-z.
BACKGROUND: Interstitial lung disease (ILD) is a common and potentially life-threatening complication for rheumatoid arthritis (RA) patients. However, there is a lack of clear prognostic factors in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) patients. The purpose of this study was to complete a systematic review and meta-analysis of the factors associated with mortality in RA-ILD patients. METHODS: Medline, EMBASE and the Cochrane Library were searched up to September 1, 2020. The Newcastle-Ottawa Scale (NOS) was applied to assess the methodological quality of the eligible studies. Study characteristics and magnitude of effect sizes were extracted. Then, pooled hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) and pooled risk ratios (RRs) with 95% CIs were calculated to assess the factors associated with mortality in RA-ILD. RESULTS: Twenty-three of 3463 articles were eligible, and ten factors associated with mortality for RA-ILD were evaluated in the meta-analysis. Older age (HRs = 1.04, 95% CI 1.03-1.05), male sex (HRs = 1.44, 95% CI 1.21-1.73), having a smoking history (HRs = 1.42, 95% CI 1.03-1.96), lower diffusing capacity of the lung for carbon monoxide (DLCO)% predicted (HRs = 0.98, 95% CI 0.97-1.00), forced vital capacity (FVC)% predicted (HRs = 0.99, 95% CI 0.98-1.00), composite physiological index (CPI) (HRs = 1.04, 95% CI 1.02-1.06), usual interstitial pneumonia (UIP) pattern on HRCT (HRs = 1.88, 95% CI 1.14-3.10 and RRs = 1.90, 95% CI 1.50-2.39), emphysema presence (HRs = 2.31, 95% CI 1.58-3.39), and acute exacerbation of ILD (HRs = 2.70, 95% CI 1.67-4.36) were associated with increased mortality in RA-ILD, whereas rheumatoid factor (RF) positive status was not associated. CONCLUSIONS: Through this systematic review and meta-analysis, we found that older age, male sex, smoking history, higher CPI, lower DLCO% predicted, lower FVC% predicted, UIP pattern on HRCT, emphysema presence and acute exacerbation of ILD were associated with an increased risk of mortality in RA-ILD.
背景：间质性肺疾病（ILD）是类风湿关节炎（RA）患者常见且潜在危及生命的并发症。然而，RA 相关间质性肺疾病（RA-ILD）患者缺乏明确的预后因素。本研究旨在对 RA-ILD 患者死亡相关因素进行系统回顾和荟萃分析。
方法：检索 Medline、EMBASE 和 Cochrane 图书馆，截至 2020 年 9 月 1 日。应用纽卡斯尔-渥太华量表（NOS）评估合格研究的方法学质量。提取研究特征和效应大小。然后，计算合并风险比（HRs）及其相应的 95%置信区间（CIs）和合并风险比（RRs）及其 95%置信区间（CIs），以评估 RA-ILD 患者死亡的相关因素。
结果：3463 篇文章中有 23 篇符合条件，对荟萃分析中与 RA-ILD 死亡率相关的 10 个因素进行了评估。年龄较大（HRs=1.04，95%CI 1.03-1.05）、男性（HRs=1.44，95%CI 1.21-1.73）、吸烟史（HRs=1.42，95%CI 1.03-1.96）、一氧化碳弥散量（DLCO）%预测值较低（HRs=0.98，95%CI 0.97-1.00）、用力肺活量（FVC）%预测值较低（HRs=0.99，95%CI 0.98-1.00）、综合生理指数（CPI）（HRs=1.04，95%CI 1.02-1.06）、高分辨率计算机断层扫描（HRCT）上常见间质性肺炎（UIP）模式（HRs=1.88，95%CI 1.14-3.10 和 RRs=1.90，95%CI 1.50-2.39）、肺气肿存在（HRs=2.31，95%CI 1.58-3.39）和 ILD 急性加重（HRs=2.70，95%CI 1.67-4.36）与 RA-ILD 死亡率增加相关，而类风湿因子（RF）阳性状态与死亡率增加无关。
结论：通过本系统评价和荟萃分析，我们发现年龄较大、男性、吸烟史、较高的 CPI、较低的 DLCO%预测值、较低的 FVC%预测值、HRCT 上的 UIP 模式、肺气肿存在和 ILD 急性加重与 RA-ILD 患者的死亡风险增加相关。
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