Bello Natalia, Meyers Kristin Joy, Workman Jennifer, Marcano Belisario José, Cervera Ricard
Eli Lilly and Company, Indianapolis, IN, USA.
RTI Health Solutions, Manchester, UK.
Rheumatol Ther. 2023 Feb;10(1):7-34. doi: 10.1007/s40744-022-00513-1. Epub 2022 Dec 6.
The objective of this work was to conduct a systematic literature review (SLR) and meta-analysis (MA) to evaluate the relative risk (RR) of venous thromboembolism (VTE) events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients with systemic lupus erythematosus (SLE) compared with patients without SLE, as well as the absolute risk (AR) (measured by incidence proportion) and incidence rate (IR) of VTE events in patients with SLE. The SLR was conducted using Embase, MEDLINE, and MEDLINE In-Process to identify observational studies evaluating the risk of VTE, DVT, and PE events in adult patients with SLE compared with the general population, published January 2000 to September 2020. Random-effects models were used as the primary approach in the MA. Heterogeneity was assessed on the basis of the I value. Sensitivity analyses were performed to assess the robustness of results to various conditions, and subgroup analysis was performed for the AR of VTE by antiphospholipid status (aPLs) and antiphospholipid syndrome (APS). Of the 50 publications included for data extraction, 44 contained data for consideration in the MA of any one of the measures of interest (RR, AR, or IR) for VTE, DVT, or PE. The pooled RR indicates statistically significantly higher risk of VTE (RR 4.38, 95% confidence interval 2.63-7.29) in patients with SLE compared with the general population. Considerable heterogeneity was present in nearly all MA (I = 75-100%). Moreover, a higher pooled AR of VTE was estimated in patients with SLE with aPLs (n/N = 0.13) and APS (n/N = 0.63) compared with patients with SLE without aPLs/APS (n/N = 0.07). Overall, there was evidence of an increased risk of VTE, DVT, and PE in patients with SLE compared with the general population.
本研究的目的是进行一项系统文献综述（SLR）和荟萃分析（MA），以评估系统性红斑狼疮（SLE）患者与非SLE患者相比发生静脉血栓栓塞（VTE）事件（包括深静脉血栓形成（DVT）和肺栓塞（PE））的相对风险（RR），以及SLE患者VTE事件的绝对风险（AR）（以发病比例衡量）和发病率（IR）。使用Embase、MEDLINE和MEDLINE In-Process进行SLR，以识别2000年1月至2020年9月发表的评估SLE成年患者与普通人群相比VTE、DVT和PE事件风险的观察性研究。随机效应模型用作MA的主要方法。基于I值评估异质性。进行敏感性分析以评估结果在各种条件下的稳健性，并按抗磷脂状态（aPLs）和抗磷脂综合征（APS）对VTE的AR进行亚组分析。在纳入数据提取的50篇出版物中，44篇包含了用于VTE、DVT或PE的任何一项感兴趣指标（RR、AR或IR）的MA中考虑的数据。汇总RR表明，与普通人群相比，SLE患者发生VTE的风险在统计学上显著更高（RR 4.38，95%置信区间2.63 - 7.29）。几乎所有MA中均存在相当大的异质性（I = 75 - 100%）。此外，与无aPLs/APS的SLE患者（n/N = 0.07）相比，有aPLs（n/N = 0.13）和APS（n/N = 0.63）的SLE患者的VTE汇总AR估计更高。总体而言，有证据表明与普通人群相比，SLE患者发生VTE、DVT和PE的风险增加。
