内皮功能障碍：接受抗逆转录病毒治疗的 HIV 患者心血管疾病的预测因子：系统评价和荟萃分析。
Endothelial dysfunction, a predictor of cardiovascular disease in HIV patients on antiretroviral therapy: A systematic review and meta-analysis.
机构信息
Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Private Bag X06, Florida 1710, South Africa.
Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Private Bag X06, Florida 1710, South Africa; Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa.
出版信息
Thromb Res. 2024 Feb;234:101-112. doi: 10.1016/j.thromres.2023.12.011. Epub 2024 Jan 4.
UNLABELLED
Aim Although antiretroviral therapy (ART) is available, the rate of new HIV infections is alarming. With this trend, it is anticipated that the use of ART will continue to rise, potentially resulting in associated vascular disorders. Therefore, we aimed to examine the impact of ART on endothelial function in people living with HIV (PLHIV), a predictor of cardiovascular diseases.
METHOD
A comprehensive search for evidence was made on PubMed and Scopus on May 06, 2023, following the Preferred Reporting Items for Systematic Review and Meta-analysis. Cochrane and Newcastle-Ottawa quality assessment scales were used to evaluate quality, while the metaHun web tool and Review Manager version 5.4.1 were used for analysis. Subgroup, sensitivity, and publication bias were conducted for each outcome measure.
RESULTS
We identified 37 studies, including a sample size of 3700 with 2265 individuals on ART. The analyzed evidence showed a large significant effect of ART on vascular cell adhesion molecule-1, with a standardized mean difference (SMD) of -1.23 (95 % CI: -1.72, -0.74; p = 0.0013). Similarly, a significant medium effect of ART was observed on intercellular cell adhesion molecule-1 in PLHIV, with an SMD of -1.28 (95 % CI: -2.00, -0.56; p = 0.0231) compared to the control group. Furthermore, ART exhibited a significant but small effect on flow-mediated dilation (FMD) with an SMD of -0.40 (95 % CI: -0.62, -0.19, p = 0.0159).
CONCLUSION
Our findings show an improved endothelial function in PLHIV on ART, as demonstrated by reduced adhesion molecules; however, ART exhibited a small effect on FMD, thus suggesting PLHIV on ART may still be at risk of endothelial dysfunction and further cardiovascular diseases.
目的
尽管有抗逆转录病毒疗法（ART）可用，但新的 HIV 感染率仍令人担忧。随着这一趋势的发展，预计 ART 的使用将会继续增加，可能会导致相关的血管疾病。因此，我们旨在研究抗逆转录病毒疗法对 HIV 感染者（PLHIV）内皮功能的影响，内皮功能是心血管疾病的一个预测指标。
方法
我们于 2023 年 5 月 6 日在 PubMed 和 Scopus 上进行了全面的证据检索，遵循系统评价和荟萃分析的首选报告项目。我们使用 Cochrane 和 Newcastle-Ottawa 质量评估量表来评估质量，同时使用 metaHun 网络工具和 Review Manager 版本 5.4.1 进行分析。对每个结果测量进行了亚组、敏感性和发表偏倚分析。
结果
我们确定了 37 项研究，其中包括 3700 名样本量，其中 2265 名接受了 ART 治疗。分析结果表明，ART 对血管细胞黏附分子-1 有很大的显著影响，标准化均数差（SMD）为-1.23（95%置信区间：-1.72，-0.74；p=0.0013）。同样，ART 对 PLHIV 中细胞间黏附分子-1 也有显著的中等影响，SMD 为-1.28（95%置信区间：-2.00，-0.56；p=0.0231），与对照组相比。此外，ART 对血流介导的扩张（FMD）有显著但较小的影响，SMD 为-0.40（95%置信区间：-0.62，-0.19，p=0.0159）。
结论
我们的研究结果表明，接受 ART 的 PLHIV 的内皮功能得到改善，表现为黏附分子减少；然而，ART 对 FMD 的影响较小，因此提示接受 ART 的 PLHIV 仍有内皮功能障碍和进一步心血管疾病的风险。
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