Gu Yu, Zhang Ting, Zhu Wenyan, Han Yang, Shi Juhong
Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.
Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China.
Arch Rheumatol. 2024 Feb 6;39(3):488-509. doi: 10.46497/ArchRheumatol.2024.10352. eCollection 2024 Sep.
This systematic review and meta-analysis aimed to investigate the prevalence of bronchiectasis (BR) in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), the association of BR with manifestations of AAV, and the features of BR in AAV.
PubMed, EMBASE, Web of Science, and Cochrane Library were searched for publications related to AAV and BR in English from January 1, 1994, until December 7, 2022. The prevalence of BR was synthesized using random-effects models, and sources of heterogeneity were assessed by sensitivity and subgroup analyses. Odds ratios (ORs) were calculated using fixed-effects models to evaluate the association of BR with manifestations of AAV. Only qualitative synthesis was performed on the features of BR.
Studies that reported on the prevalence (n=24), the association (n=6), and the features (n=8) of BR were identified. The pooled overall prevalence of BR among AAV was 19% (95% confidence interval [CI] 13-27%). The prevalence of patients with myeloperoxidase (MPO)-ANCA was significantly higher than those with proteinase 3-ANCA (28% 13%, p=0.01). The female sex (OR=2.41), peripheral neuropathy (OR=4.58), MPO-ANCA (OR=4.73), and microscopic polyangiitis (OR=2.72) were associated with BR in AAV. Compared to individuals without BR, AAV-BR patients exhibited relatively lower levels of proteinuria. The diagnosis of BR could follow, be concomitant to, or precede that of AAV. However, BR usually did not respond to immunosuppressive therapy.
AAV with BR is a common condition with special manifestations. The association of BR with AAV may not be accidental; however, the underlying pathogenesis remains to be clarified.
本系统评价和荟萃分析旨在调查抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）中支气管扩张（BR）的患病率、BR与AAV临床表现的相关性以及AAV中BR的特征。
检索PubMed、EMBASE、Web of Science和Cochrane图书馆，查找1994年1月1日至2022年12月7日期间与AAV和BR相关的英文出版物。使用随机效应模型综合BR的患病率，并通过敏感性和亚组分析评估异质性来源。使用固定效应模型计算比值比（OR），以评估BR与AAV临床表现的相关性。仅对BR的特征进行定性综合分析。
确定了报告BR患病率（n = 24）、相关性（n = 6）和特征（n = 8）的研究。AAV中BR的总体合并患病率为19%（95%置信区间[CI]13 - 27%）。髓过氧化物酶（MPO）-ANCA患者的患病率显著高于蛋白酶3-ANCA患者（28%对13%，p = 0.01）。女性（OR = 2.41）、周围神经病变（OR = 4.58）、MPO-ANCA（OR = 4.73）和显微镜下多血管炎（OR = 2.72）与AAV中的BR相关。与无BR的个体相比，AAV-BR患者的蛋白尿水平相对较低。BR的诊断可以在AAV诊断之后、同时或之前出现。然而，BR通常对免疫抑制治疗无反应。
合并BR的AAV是一种具有特殊表现的常见疾病。BR与AAV的关联可能并非偶然；然而，其潜在发病机制仍有待阐明。
