CHU Amiens-Picardie, 36673Department of Internal Medicine, Amiens, France.
CHU de Besançon, Vascular Medicine Unit, 55049Vascular Surgery Department, Besançon, France.
Lupus. 2022 Nov;31(13):1595-1605. doi: 10.1177/09612033221126852. Epub 2022 Sep 15.
Livedo is a well-known skin condition in patients with systemic lupus erythematosus (SLE) which correspond to small vessels involvement. The influence of antiphospholipid antibodies (aPL) on the occurrence of livedo is controversial. The aim of our study was to estimate the risk of livedo associated with aPL in patients with SLE.
We conducted a systematic review and meta-analysis of the literature from 1977 to 2021 to estimate the risk of livedo in SLE patients according to different aPL profiles. Data sources were PubMed, Embase, Cochrane Library, hand search, and reference lists of studies. Studies were selected if they included SLE patients with descriptions of the exposure to aPL and the outcome (). Two independent investigators assessed study eligibility, quality, and extracted patient characteristics from each study as well as exposure (aPL) and outcome (). Risk estimates were pooled using random effects models and sensitivity analyses. For all stages of the meta-analysis, we followed the PRISMA guidelines. PROSPERO registration number: CRD42015027377.
Of the 2,355 articles identified, 27 were included with a total of 4,810 SLE patients. The frequency of livedo was 25.5% in aPL-positive patients and 13.3% in aPL-negative patients. The overall Odds Ratio (OR) for livedo in aPL-positive patients compared to aPL-negative patients was 2.91 (95% CI; 2.17-3.90). The risk of livedo was significantly increased for most of aPL subtypes, including lupus anticoagulant (LA) (OR = 4.45 [95% CI; 2.21-8.94]), IgG anticardiolipin (OR = 3.95 [95% CI; 2.34-6.65]), and IgG anti-β-glycoprotein 1 (OR = 3.49 [95% CI; 1.68-7.27]).
We demonstrated in this meta-analysis an excess risk of livedo in aPL-positive SLE patients compared to aPL-negative patients. For daily practice, in patients with SLE, livedo associated with aPL could correspond to a peculiar group of patients with small vessel disease. Livedo could be a good candidate for inclusion in future classification criteria for antiphospholipid syndrome.
网状青斑是系统性红斑狼疮（SLE）患者的一种常见皮肤表现，与小血管受累相对应。抗磷脂抗体（aPL）对网状青斑发生的影响存在争议。我们的研究目的是评估 SLE 患者中 aPL 与网状青斑发生的相关性风险。
我们对 1977 年至 2021 年的文献进行了系统回顾和荟萃分析，以根据不同的 aPL 谱估计 SLE 患者发生网状青斑的风险。数据来源为 PubMed、Embase、Cochrane 图书馆、手工检索以及研究参考文献列表。如果研究包含描述 aPL 暴露和结局的 SLE 患者，则纳入研究（网状青斑）。两名独立的研究者评估了研究的入选标准、质量，并从每项研究中提取了患者特征、暴露（aPL）和结局（）。使用随机效应模型汇总风险估计值，并进行敏感性分析。在荟萃分析的所有阶段，我们都遵循 PRISMA 指南。PROSPERO 注册号：CRD42015027377。
在 2355 篇文章中，有 27 篇被纳入，共纳入 4810 例 SLE 患者。aPL 阳性患者中网状青斑的发生率为 25.5%，aPL 阴性患者中为 13.3%。与 aPL 阴性患者相比，aPL 阳性患者发生网状青斑的总体优势比（OR）为 2.91（95%CI：2.17-3.90）。大多数 aPL 亚型的网状青斑风险显著增加，包括狼疮抗凝物（LA）（OR=4.45[95%CI：2.21-8.94]）、IgG 抗心磷脂抗体（OR=3.95[95%CI：2.34-6.65]）和 IgG 抗-β2-糖蛋白 1 抗体（OR=3.49[95%CI：1.68-7.27]）。
在这项荟萃分析中，我们证明与 aPL 阴性患者相比，aPL 阳性 SLE 患者发生网状青斑的风险增加。在 SLE 患者中，网状青斑与 aPL 相关可能对应于小血管疾病的一个特殊患者群体。网状青斑可能是纳入未来抗磷脂综合征分类标准的一个很好的候选指标。
