Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Department of Rheumatology, American University of Beirut, Beirut, Lebanon.
Autoimmun Rev. 2024 Nov;23(11):103657. doi: 10.1016/j.autrev.2024.103657. Epub 2024 Oct 2.
Primary antiphospholipid syndrome (PAPS) has been associated with an increase in clinical events associated with atherosclerotic vascular disease. Intima media thickness (IMT) of carotid arteries is a surrogate marker of atherosclerotic vascular disease.
To conduct a systematic review and meta-analysis of studies evaluating IMT and their clinical correlates in PAPS.
Systematic search of EMBASE and PubMed databases from January 2000 to December 2023; we employed random effect meta-analyses for continuous outcomes and Peto's odds ratio for rare events.
The meta-analysis included 21 studies (20 case control and 1 cohort) showing that PAPS patients (n = 1103) had thicker IM than controls (n = 832) (p < 0.0001) with wide heterogeneity (I = 86.9 %); PAPS patients (n = 782) also had a greater pooled prevalence of carotid plaques than controls (n = 537) (13.1 % vs 2.97 %, p < 0.0001). A sensitivity analysis by meta-regression indicated that mean age, gender, disease duration, lipid profile, blood pressures, smoking and statin use all explained the heterogeneity variance; a sensitivity analysis by subgroups confirmed smoking status and statin use as explanatory variables with the addition of ethnicity.
Atherosclerosis of the carotid artery represents a clinical feature of PAPS in relation to the traditional risk factors and to statin use. Minimising the atherogenic risk with statins could reduce the late arterial atherothrombotic risks of PAPS.
原发性抗磷脂综合征（PAPS）与动脉粥样硬化性血管疾病相关的临床事件增加有关。颈动脉内膜中层厚度（IMT）是动脉粥样硬化性血管疾病的替代标志物。
对评估 PAPS 中 IMT 及其临床相关性的研究进行系统评价和荟萃分析。
对 EMBASE 和 PubMed 数据库进行系统检索，检索时间为 2000 年 1 月至 2023 年 12 月；我们对连续结局采用随机效应荟萃分析，对罕见事件采用 Peto 的优势比。
荟萃分析纳入了 21 项研究（20 项病例对照和 1 项队列研究），结果显示 PAPS 患者（n=1103）的 IMT 比对照组（n=832）厚（p<0.0001），异质性较大（I=86.9%）；PAPS 患者（n=782）颈动脉斑块的总体患病率也高于对照组（n=537）（13.1% vs 2.97%，p<0.0001）。meta 回归的敏感性分析表明，平均年龄、性别、疾病持续时间、血脂谱、血压、吸烟和他汀类药物使用均解释了异质性方差；亚组分析证实，吸烟状况和他汀类药物使用是具有解释性的变量，同时还包括种族因素。
与传统危险因素和他汀类药物使用相关，颈动脉粥样硬化是 PAPS 的临床特征。通过他汀类药物降低动脉粥样硬化风险可能会降低 PAPS 的晚期动脉血栓形成风险。
