特发性炎性肌病患者快速进展性间质性肺病发生的相关因素：一项系统评价和荟萃分析
Associated factors in the development of rapidly progressive interstitial lung disease in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis.
作者信息
Yuan Weiwei, Zhou Xuefei, Yang Yahui, Zhang Shijie, He Xing, Ji Jiaqi
机构信息
School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Pediatrics, The First People's Hospital of Shuangliu District/West China (Airport) Hospital Sichuan University, Chengdu, China.
出版信息
Front Immunol. 2025 Aug 5;16:1628928. doi: 10.3389/fimmu.2025.1628928. eCollection 2025.
OBJECTIVES
Interstitial lung disease (ILD), the main pulmonary manifestation of idiopathic inflammatory myopathy (IIM), frequently develops into rapidly progressive ILD (RP-ILD) with significantly worse prognosis. This meta-analysis identified risk and protective factors associated with developing RP-ILD in IIM patients.
METHODS
PubMed, Embase, Web of Science, and Scopus (up to October 2024) were searched, analyzing 21 retrospective studies (2,099 patients). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were collected. Subgroup analysis was performed based on the RP-ILD definition. Sensitivity analysis and publication bias assessments (Egger's test and trim-and-fill method) were performed.
RESULTS
The associated risk factors for RP-ILD development in IIM patients included age (OR = 1.014, 95% CI: 1.002-1.025), clinically amyopathic dermatomyositis (OR = 3.023, 95% CI: 1.491-6.130), mechanic's hands (OR = 1.421, 95% CI: 1.054-1.915), fever (OR = 3.090, 95% CI: 1.933-4.939), pulmonary infection (OR = 2.610, 95% CI: 1.457-4.677), anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies (OR = 6.044, 95% CI: 4.331-8.435), anti-Ro-52 antibodies (OR = 2.425, 95% CI: 1.807-3.255), and elevated levels of ferritin (OR = 5.844, 95% CI: 4.121-8.287), lactate dehydrogenase (OR = 3.627, 95% CI: 2.406-5.466), erythrocyte sedimentation rate (OR = 1.598, 95% CI: 1.089-2.344), aspartate aminotransferase (OR = 2.666, 95% CI: 1.864-3.814), alanine transaminase (OR = 2.702, 95% CI: 1.737-4.201), and C-reactive protein (OR = 3.366, 95% CI: 2.149-5.274), whereas longer disease duration (OR = 0.790, 95% CI: 0.638-0.977) and dysphagia (OR = 0.773, 95% CI: 0.653-0.916) were potential protective factors.
CONCLUSION
This meta-analysis of 21 retrospective studies identified potential risk and protective factors associated with RP-ILD development in IIM patients, providing a basis for early identification and management.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2025-4-0059/, identifier INPLASY202540059.
目的
间质性肺病（ILD）是特发性炎性肌病（IIM）的主要肺部表现，常发展为快速进展性ILD（RP - ILD），预后明显更差。本荟萃分析确定了与IIM患者发生RP - ILD相关的风险和保护因素。
方法
检索了PubMed、Embase、Web of Science和Scopus（截至2024年10月），分析了21项回顾性研究（2099例患者）。收集了合并比值比（OR）及95%置信区间（CI）。基于RP - ILD的定义进行亚组分析。进行了敏感性分析和发表偏倚评估（Egger检验和修剪填充法）。
结果
IIM患者发生RP - ILD的相关危险因素包括年龄（OR = 1.014，95% CI：1.002 - 1.025）、临床无肌病性皮肌炎（OR = 3.023，95% CI：1.491 - 6.130）、技工手（OR = 1.421，95% CI：1.054 - 1.915）、发热（OR = 3.090，95% CI：1.933 - 4.939）、肺部感染（OR = 2.610，95% CI：1.457 - 4.677）、抗黑色素瘤分化相关基因5（抗MDA5）抗体（OR = 6.044，95% CI：4.331 - 8.435）、抗Ro - 52抗体（OR = 2.425，95% CI：1.807 - 3.255）以及铁蛋白水平升高（OR = 5.844，9% CI：4.121 - 8.287）、乳酸脱氢酶（OR = 3.627，95% CI：2.406 - 5.466）、红细胞沉降率（OR = 1.598，95% CI：1.089 - 2.344）、天冬氨酸转氨酶（OR = 2.666，95% CI：1.864 - 3.814）、丙氨酸转氨酶（OR = 2.702，95% CI：1.737 - 4.201）和C反应蛋白（OR = 3.366，95% CI：2.149 - 5.274），而病程较长（OR = 0.790，95% CI：0.638 - 0.977）和吞咽困难（OR = 0.773，95% CI：0.653 - 0.916）是潜在的保护因素。
结论
这项对21项回顾性研究的荟萃分析确定了与IIM患者发生RP - ILD相关的潜在风险和保护因素，为早期识别和管理提供了依据。
系统评价注册
https://inplasy.com/inplasy - 2025 - 4 - 0059/，标识符INPLASY202540059。
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