Ly Sophia, Manjaly Priya, Kamal Kanika, Shields Ali, Wafae Bruna, Afzal Najiba, Drake Lara, Sanchez Katherine, Gregoire Samantha, Zhou Guohai, Mita Carol, Mostaghimi Arash
College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
Am J Clin Dermatol. 2023 Nov;24(6):875-893. doi: 10.1007/s40257-023-00805-4. Epub 2023 Jul 18.
Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking.
The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA.
We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023.
We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle-Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24-24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31-9.23), vitiligo (OR 5.30, 95% CI 1.86-15.10), metabolic syndrome (OR 5.03, 95% CI 4.18-6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51-7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14-0.99) and colorectal cancer (OR 0.61, 95% CI 0.42-0.89).
These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.
斑秃（AA）是一种复杂的自身免疫性疾病，可导致非瘢痕性脱发。近年来，许多研究为AA患者中存在的合并症提供了新证据。然而，一些研究结果相互矛盾，且缺乏采用综合方法的分析。
我们研究的目的是对与AA相关的医学合并症进行最新的系统评价和荟萃分析。
我们在PubMed、Embase和Web of Science中检索了从创刊至2023年2月1日发表的关于AA患者医学合并症的病例对照研究、横断面研究和队列研究。
我们筛选了3428篇摘要和标题，并审查了345篇全文文章以确定其是否符合纳入标准。最终，分析了102项研究，包括680,823例AA患者和72,011,041例健康对照。几乎所有纳入研究（102项研究中的100项）的质量为满意至高质量（纽卡斯尔-渥太华量表评分≥4）。在AA患者中，与健康对照相比比值比（OR）最高且有多项研究数据的合并症包括维生素D缺乏（OR 10.13，95%CI 4.24-24.20）、系统性红斑狼疮（OR 5.53，95%CI 3.31-9.23）、白癜风（OR 5.30，95%CI 1.86-15.10）、代谢综合征（OR 5.03，95%CI 4.18-6.06）和桥本甲状腺炎（OR 4.31，95%CI 2.51-7.40）。AA可能是某些疾病的保护因素，与健康对照相比，AA组的患病几率较低，如肠易激综合征（OR 0.38，95%CI 0.14-0.99）和结直肠癌（OR 0.61，95%CI 0.42-0.89）。
这些发现证实并梳理了AA患者合并症的风险。应进一步开展工作以确定潜在的病理生理学机制并了解合适的筛查标准。
