Florida State University, Daytona Beach, FL, USA.
Section of Rheumatology, Yale School of Medicine, New Haven, CT, USA.
Autoimmun Rev. 2022 Oct;21(10):103158. doi: 10.1016/j.autrev.2022.103158. Epub 2022 Jul 28.
Microvascular renal lesions have been described in patients with antiphospholipid antibodies (aPL), however their association with aPL is inconsistent among studies. Therefore, our objective was to investigate associations between microvascular renal lesions and aPL among systemic lupus erythematosus (SLE) patients.
Studies were selected if they included SLE patients with and without aPL positivity with a description of kidney biopsy identifying acute and/or chronic microvascular renal lesions as well as lupus nephritis. Data sources were Pubmed, Embase, Cochrane Library, hand search, congress abstracts, and reference lists of studies, without language restrictions. Risk estimates were independently extracted by 2 investigators. Pooled effect estimates were obtained by using the Mantel-Haenszel method (random effects).
Of 1860 identified records obtained between 1991 and 2021, 35 published studies (10 cohorts, 7 case-control, 18 cross-sectional) met inclusion criteria, including 3035 SLE patients according to American College of Rheumatology criteria and 454 cases of microvascular renal lesions. Frequency of microvascular renal lesions in aPL-positive vs. aPL-negative SLE patients was 31.3% vs. 10.4%, respectively. The overall pooled odds ratios (OR) for microvascular renal lesions in aPL-positive vs. aPL-negative SLE patients was 3.03 (95% confidence interval [CI], 2.25-4.09). The risk of microvascular renal lesions was the highest for lupus anticoagulant (OR = 4.84 [95% CI, 2.93 to 8.02]) and IgG anticardiolipin antibodies (OR = 3.12 [95% CI,1.08-9.02]) while the association with anti-β-glycoprotein I antibodies (OR = 1.88 [95% CI, 0.25-14.14]) did not reach statistical significance. Furthermore, aPL were not associated with any classes of lupus nephritis.
In SLE patients, aPL-positivity is associated with a significant 3- to 5-fold increased risk for specific microvascular renal lesions. This risk is mainly driven by lupus anticoagulant and IgG anticardiolipin antibodies. Our results support the inclusion of microvascular renal lesions as new criteria for definite antiphospholipid syndrome.
已有研究描述了抗磷脂抗体（aPL）患者存在微血管肾损伤，但这些研究中 aPL 与微血管肾损伤的相关性并不一致。因此，我们的目的是探讨系统性红斑狼疮（SLE）患者中微血管肾损伤与 aPL 的相关性。
如果研究纳入了描述肾活检中存在急性和/或慢性微血管肾损伤及狼疮肾炎的伴有和不伴有 aPL 阳性的 SLE 患者，并对这些患者进行了 aPL 阳性和 aPL 阴性分组，则将其纳为研究对象。检索文献数据库包括 Pubmed、Embase、Cochrane 图书馆、手工检索、会议摘要和参考文献列表，不限制语言。两名研究者独立提取风险估计值。采用 Mantel-Haenszel 方法（随机效应）获得汇总效应估计值。
在 1991 年至 2021 年间共检索到 1860 篇文献，其中 35 篇发表的研究（10 项队列研究、7 项病例对照研究、18 项横断面研究）符合纳入标准，共纳入了 3035 例符合美国风湿病学会标准的 SLE 患者和 454 例微血管肾损伤患者。aPL 阳性 SLE 患者中微血管肾损伤的发生率为 31.3%，aPL 阴性 SLE 患者中微血管肾损伤的发生率为 10.4%。aPL 阳性 SLE 患者发生微血管肾损伤的总体汇总优势比（OR）为 3.03（95%置信区间[CI]：2.25-4.09）。狼疮抗凝物（OR=4.84，95%CI：2.93-8.02）和 IgG 型抗心磷脂抗体（OR=3.12，95%CI：1.08-9.02）与微血管肾损伤的相关性最高，而抗β2-糖蛋白 I 抗体（OR=1.88，95%CI：0.25-14.14）与微血管肾损伤的相关性无统计学意义。此外，aPL 与任何类型的狼疮肾炎均无关。
在 SLE 患者中，aPL 阳性与特定的微血管肾损伤发生风险显著增加 3-5 倍相关。这种风险主要由狼疮抗凝物和 IgG 型抗心磷脂抗体驱动。我们的研究结果支持将微血管肾损伤纳入明确抗磷脂综合征的新标准。
