系统性自身免疫性风湿疾病相关间质性肺疾病病情恶化的决定因素：队列研究的系统评价与荟萃分析
Determinants for worsening in systemic autoimmune rheumatic disease-associated interstitial lung disease: a systematic review and meta-analysis of cohort studies.
作者信息
Yao Jiaheng, Wang Jun, Guo Luhan, Su Peipei, Li Jiansheng, Li Bin
机构信息
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.
The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China.
出版信息
Front Med (Lausanne). 2024 Nov 27;11:1465753. doi: 10.3389/fmed.2024.1465753. eCollection 2024.
BACKGROUND
To identify risk factors for progression, acute exacerbation (AE), and the development of rapidly progressive interstitial lung disease (RP-ILD) in Systemic autoimmune rheumatic disease-associated interstitial lung disease (SARD-ILD).
METHODS
We systematically searched PubMed, EMBASE, Scopus, the Cochrane Library, and Web of Science databases to identify eligible cohort studies up until January 01, 2024. Two reviewers independently screened the literature and extracted data. We employed the Newcastle-Ottawa Scale (NOS) to assess study quality and performed meta-analyses using STATA software.
RESULTS
This review included 50 studies. For progression, 28 studies were included, four significant risk factors were identified: male (OR = 1.97, 95% CI 1.26-3.08, < 0.001), UIP patterns on HRCT (OR = 1.94, 95% CI 1.48-2.54, < 0.001), extensive lung involvement (OR = 2.15, 95% CI 1.66-2.80, < 0.001), and age (OR = 1.07, 95% CI 1.05-1.10, < 0.001); and 11 potential risk factors. Seven studies were included in AE, and three potential risk factors were highlighted: FVC, UIP patterns on HRCT, and smoking history. In RP-ILD, 15 studies were included. Three risk factors were determined: High CRP (OR = 2.45, 95% CI 1.87-3.21, < 0.001), Ro-52 positivity (OR = 5.35, 95% CI 3.46-8.29, < 0.001), and MDA5 antibodies (OR = 2.09, 95% CI 1.47-2.95, < 0.001); along with 10 potential risk factors.
CONCLUSION
Our meta-analysis identified male sex, UIP pattern on HRCT, extensive lung involvement, and advanced age as significant risk factors for the progression of SARD-ILD. High CRP, Ro-52 positivity, and MDA5 antibodies were significant risk factors for developing of RP-ILD in patients with IIM. We also discovered several potential risk factors that may be associated with the progression of SARD-ILD and acute exacerbation, as well as the occurrence of RP-ILD in IIM patients.
SYSTEMATIC REVIEW REGISTRATION
背景
确定系统性自身免疫性风湿性疾病相关间质性肺病（SARD-ILD）进展、急性加重（AE）和快速进展性间质性肺病（RP-ILD）发生的危险因素。
方法
我们系统检索了PubMed、EMBASE、Scopus、Cochrane图书馆和Web of Science数据库，以识别截至2024年1月1日的符合条件的队列研究。两名研究者独立筛选文献并提取数据。我们采用纽卡斯尔-渥太华量表（NOS）评估研究质量，并使用STATA软件进行荟萃分析。
结果
本综述纳入了50项研究。对于疾病进展，纳入了28项研究，确定了4个显著危险因素：男性（OR = 1.97，95%CI 1.26 - 3.08，P < 0.001）、HRCT上的UIP模式（OR = 1.94，95%CI 1.48 - 2.54，P < 0.001）、广泛的肺部受累（OR = 2.15，95%CI 1.66 - 2.80，P < 0.001）和年龄（OR = 1.07，95%CI 1.05 - 1.10，P < 0.001）；以及11个潜在危险因素。AE纳入了7项研究，突出了3个潜在危险因素：FVC、HRCT上的UIP模式和吸烟史。在RP-ILD方面，纳入了15项研究。确定了3个危险因素：高CRP（OR = 2.45，95%CI 1.87 - 3.21，P < 0.001）、Ro-52阳性（OR = 5.35，95%CI 3.46 - 8.29，P < 0.001）和MDA5抗体（OR = 2.09，95%CI 1.47 - 2.95，P < 0.001）；以及10个潜在危险因素。
结论
我们的荟萃分析确定男性、HRCT上的UIP模式、广泛的肺部受累和高龄是SARD-ILD进展的显著危险因素。高CRP、Ro-52阳性和MDA5抗体是IIM患者发生RP-ILD的显著危险因素。我们还发现了几个可能与SARD-ILD进展、急性加重以及IIM患者中RP-ILD发生相关的潜在危险因素。
系统评价注册
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