Huang Xiaolan, Jia Nan, Xiao Fei, Sun Chunrong, Zhu Jia, Lai Jianming, Cui Xiaodai
Experiment Center, Capital Institute of Pediatrics, Beijing, China.
Department of Rheumatism and Immunity, Capital Institute of Pediatrics, Beijing, China.
Int Arch Allergy Immunol. 2022;183(1):116-126. doi: 10.1159/000518321. Epub 2021 Sep 27.
The aim of this study was to assess the differences between childhood-onset and adult-onset systemic lupus erythematosus (cSLE and aSLE) for clinical manifestations and mortality using a meta-analytic approach.
The PubMed, EMBASE, and the Cochrane library were searched for eligible studies published between January 1982 and March 2021. The odds ratio (OR) with 95% confidence interval was used to calculate the pooled effect estimates using the random-effects model.
Thirty-four studies involving 21,946 SLE patients were included. cSLE was associated with an increased risk of malar rash (OR: 1.64; p < 0.001), ulcers/mucocutaneous involvement (OR: 1.22; p = 0.039), general neurological involvement (OR: 1.52; p < 0.001), seizures (OR: 1.92; p < 0.001), general renal involvement (OR: 2.08; p < 0.001), proteinuria (OR: 1.35; p = 0.015), urinary cellular casts (OR: 1.67; p = 0.047), fever (OR: 2.31; p < 0.001), anemia (OR: 1.91; p < 0.001), thrombocytopenia (OR: 1.41; p < 0.001), leucopenia (OR: 1.57; p = 0.017), lymphadenopathy (OR: 2.40; p < 0.001), and cutaneous vasculitis (OR: 1.72; p = 0.001) as compared with aSLE. Moreover, cSLE versus aSLE was associated with a reduced risk of articular manifestations (OR: 0.63; p = 0.001), pulmonary involvement (OR: 0.54; p = 0.001), and pleuritis (OR: 0.61; p < 0.001). There were no significant differences between cSLE and aSLE for mortality risk (OR: 1.20; p = 0.203).
We found that certain clinical manifestations of SLE are different in cSLE and aSLE. Moreover, the mortality risk of cSLE and aSLE was not significantly different.
本研究旨在采用荟萃分析方法评估儿童期起病和成人期起病的系统性红斑狼疮（儿童系统性红斑狼疮和成人系统性红斑狼疮）在临床表现和死亡率方面的差异。
检索了PubMed、EMBASE和Cochrane图书馆，以查找1982年1月至2021年3月期间发表的符合条件的研究。使用随机效应模型，采用95%置信区间的比值比（OR）来计算合并效应估计值。
纳入了34项涉及21946例系统性红斑狼疮患者的研究。与成人系统性红斑狼疮相比，儿童系统性红斑狼疮出现以下情况的风险增加：蝶形红斑（OR：1.64；p<0.001）、溃疡/皮肤黏膜受累（OR：1.22；p=0.039）、一般神经受累（OR：1.52；p<0.001）、癫痫发作（OR：1.92；p<0.001）、一般肾脏受累（OR：2.08；p<0.001）、蛋白尿（OR：1.35；p=0.015）、尿细胞管型（OR：1.67；p=0.047）、发热（OR：2.31；p<0.001）、贫血（OR：1.91；p<0.001）、血小板减少（OR：1.41；p<0.001）、白细胞减少（OR：1.57；p=0.017）、淋巴结病（OR：2.40；p<0.001）和皮肤血管炎（OR：1.72；p=0.001）。此外，儿童系统性红斑狼疮与成人系统性红斑狼疮相比，出现关节表现（OR：0.63；p=0.001）、肺部受累（OR：0.54；p=0.001）和胸膜炎（OR：0.61；p<0.001）的风险降低。儿童系统性红斑狼疮和成人系统性红斑狼疮在死亡风险方面无显著差异（OR：1.20；p=0.203）。
我们发现系统性红斑狼疮的某些临床表现在儿童系统性红斑狼疮和成人系统性红斑狼疮中有所不同。此外，儿童系统性红斑狼疮和成人系统性红斑狼疮的死亡风险无显著差异。
