Department of Rheumatology, American University of Beirut, Beirut, Lebanon.
Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University of Rome, Rome, Italy.
Clin Rheumatol. 2022 Dec;41(12):3769-3776. doi: 10.1007/s10067-022-06326-5. Epub 2022 Aug 6.
To perform a systematic review and meta-analysis of studies reporting data on atherosclerosis and inflammatory markers in familial Mediterranean fever (FMF).
EMBASE and PubMed databases were screened according to PRISMA guidelines from inception to January 2022 for articles reporting measurements of the intima media thickness (IMT) of carotid arteries and eventually carotid plaques; random effect meta-analyses for continuous outcomes and Peto's odds ratio for rare events were employed.
The screening and selection search strategy yielded 18 case controls studies (16 full papers and 2 abstracts); the IMT was greater in FMF (n = 1112) than in controls (n = 901) (p < 0.0001) with wide heterogeneity (I = 86.4%); a sensitivity analysis according to mean age of participants, male to female ratio, disease duration, C-reactive protein (CRP), serum amyloid A (SAA), fibrinogen (FNG), atherogenic index of plasma (AIP), colchicine use and NOQAS revealed that the heterogeneity variance was partly explained by CRP (p = 0.01) and to a much lesser extent by the AIP (p = 0.10). The pooled prevalence of carotid plaques was greater in FMF (n = 137) than in controls (n = 156) (19% vs 8.3%, p = 0.02) with low heterogeneity.
FMF is characterised by premature atherosclerosis expressed as a thicker intima media and a greater prevalence of carotid plaques, partially related to the C-reactive protein, as expected by the autoinflammatory nature of FMF. Key Points • Familial Mediterranean fever is characterised by premature atherosclerosis. • C-reactive protein relates to intima media thickness in keeping with the autoinflammatory nature Familial Mediterranean fever. • Targeting the inter-critical low-grade inflammation may be relevant to minimise the additional cardiovascular risk posed by premature atherosclerosis.
系统评价和荟萃分析报告家族性地中海热（FMF）患者动脉粥样硬化和炎症标志物数据的研究。
根据 PRISMA 指南，从建库至 2022 年 1 月，在 EMBASE 和 PubMed 数据库中进行筛选，以检索报告颈动脉内-中膜厚度（IMT）和颈动脉斑块测量值的文章；采用连续结果的随机效应荟萃分析和罕见事件的 Peto 比值比。
筛选和选择的搜索策略产生了 18 项病例对照研究（16 篇全文和 2 篇摘要）；FMF 组（n=1112）的 IMT 大于对照组（n=901）（p<0.0001），异质性较大（I=86.4%）；根据参与者的平均年龄、男女比例、疾病持续时间、C 反应蛋白（CRP）、血清淀粉样蛋白 A（SAA）、纤维蛋白原（FNG）、血浆致动脉粥样硬化指数（AIP）、秋水仙碱使用和 NOQAS 进行的敏感性分析表明，CRP（p=0.01）部分解释了异质性方差，而 AIP 则解释得较少（p=0.10）。FMF 组（n=137）颈动脉斑块的总患病率大于对照组（n=156）（19% vs 8.3%，p=0.02），异质性较低。
FMF 的特征是动脉粥样硬化提前发生，表现为内-中膜增厚和颈动脉斑块的患病率增加，这部分与 CRP 有关，这与 FMF 的自身炎症性质相符。关键要点：• 家族性地中海热的特征是动脉粥样硬化提前发生。• CRP 与内-中膜厚度有关，符合家族性地中海热的自身炎症性质。• 针对缓解期的低度炎症可能与减轻因动脉粥样硬化提前发生而带来的额外心血管风险有关。
