González-Treviño Mariana, Figueroa-Parra Gabriel, Yang Jeffrey X, Prokop Larry J, Gamal Sherif M, García Mercedes A, James Judith A, Knight Jason S, Murad M Hassan, Narvaez Javier, Pons-Estel Bernardo A, Quintana Rosana M, Specks Ulrich, Yang Xuwei, Duarte-García Alí
Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Rheumatology (Oxford). 2025 Apr 1;64(4):1598-1608. doi: 10.1093/rheumatology/keae632.
To assess the association of aPL and diffuse alveolar haemorrhage (DAH) in patients with SLE by performing a systematic review and meta-analysis.
Multiple databases were systematically searched from inception to February 2024. Studies were eligible if they included patients with SLE (population), reported aPL status (exposure), and DAH (outcome). We pooled the estimates as odds ratio (OR) using fixed-effect models. We examined the association between aPL and DAH, as well as associations based on aPL subtypes or concomitant APS.
Out of 454 screened studies, nine were included in meta-analysis, encompassing 7746 patients with SLE, of whom 2016 (26.0%) were aPL-positive and 163 (2.1%) had DAH. Patients with SLE and positive aPL (any) were more likely to develop DAH than aPL-negative patients (OR = 1.76, 95% CI 1.24-2.49; I2 = 0%). Patients with SLE and positive LA (OR = 1.76, 95% CI 1.06-2.93, I2 = 35%) or positive anticardiolipin IgG (OR = 1.62, 95% CI 1.13-2.34, I2 = 0%) had a higher likelihood of developing DAH compared with patients that were negative for these aPL. An APS diagnosis was associated with a 2.5-fold increased likelihood of DAH compared with subjects without APS (OR = 2.46, 95% CI 1.23-4.92, I2 = 0%). Positivity of anti-β2 glycoprotein I IgG was not significantly associated with DAH among patients with SLE (OR = 0.78, 95% CI 0.45-1.36, I2 = 0%).
In patients with SLE, aPL positivity increases the risk of DAH compared with aPL-negative patients, particularly in those positive for LA and anticardiolipin IgG.
通过进行系统评价和荟萃分析，评估系统性红斑狼疮（SLE）患者中抗磷脂抗体（aPL）与弥漫性肺泡出血（DAH）之间的关联。
从数据库建立至2024年2月对多个数据库进行系统检索。纳入的研究需符合以下条件：纳入SLE患者（研究对象）、报告aPL状态（暴露因素）以及DAH（研究结局）。我们使用固定效应模型将估计值合并为比值比（OR）。我们研究了aPL与DAH之间的关联，以及基于aPL亚型或合并抗磷脂综合征（APS）的关联。
在筛选的454项研究中，9项纳入荟萃分析，涵盖7746例SLE患者，其中2016例（26.0%）aPL阳性，163例（2.1%）发生DAH。SLE且aPL（任何类型）阳性的患者比aPL阴性患者更易发生DAH（OR = 1.76，95%CI 1.24 - 2.49；I² = 0%）。SLE且狼疮抗凝物（LA）阳性（OR = 1.76，95%CI 1.06 - 2.93，I² = 35%）或抗心磷脂IgG阳性（OR = 1.62，95%CI 1.13 - 2.34，I² = 0%）的患者与这些aPL阴性的患者相比，发生DAH的可能性更高。与无APS的受试者相比，APS诊断与DAH发生可能性增加2.5倍相关（OR = 2.46，95%CI 1.23 - 4.92，I² = 0%）。SLE患者中抗β2糖蛋白I IgG阳性与DAH无显著关联（OR = 0.78，95%CI 0.45 - 1.36，I² = 0%）。
在SLE患者中，与aPL阴性患者相比，aPL阳性会增加DAH风险，尤其是LA和抗心磷脂IgG阳性的患者。
