系统性硬化症并发间质性肺病危险因素的Meta分析
Risk Factors for Interstitial Lung Disease in Patients with Systemic Sclerosis: A Meta-Analysis
摘要: 目的：探讨系统性硬化症(systemic sclerosis, SSc)患者并发间质性肺病(interstitial lung disease, ILD)的可能危险因素。为早期发现和治疗SSc-ILD提供依据。方法：根据检索词在PubMed、EMBASE、Cochrane library以及中国知网进行搜索，选取2023年12月20日之前发表的所有论文，筛选出符合评价标准的文献，使用Revman 5.4软件进行数据处理。结果：最终共纳入文献7篇，共计1008例SSc患者，535例患者合并ILD。本研究共探讨7个可能的危险因素，Meta分析结果显示：(1) 共4篇文献研究了咳嗽与SSc患者发生ILD的关系，结果无统计学意义[OR = 1.42, 95% CI (0.46, 4.39), P = 0.54]。(2) 共3篇文献研究了咳嗽与SSc患者发生ILD的关系，结果[OR = 1.15, 95% CI (0.37, 3.54), P = 0.81]。(3) 共4篇文献研究了疾病类型为dcSSc与SSc患者发生ILD的关系，结果具有统计学意义[OR = 3.18, 95% CI (2.19, 4.62), P < 0.00001]。(4) 共3篇文献研究了肺动脉高压(pulmonary arterial hypertension, PAH)与SSc患者发生ILD的关系，结果具有统计学意义[OR = 5.60, 95% CI (2.57, 12.18), P < 0.0001]。(5) 共7篇文献研究了抗核抗体(anti-nuclear antibody, ANA)与SSc患者发生ILD的关系，结果具有统计学意义[OR = 2.37, 95% CI (1.63, 3.45), P < 0.00001]。(6) 共4篇文献研究了抗着丝点抗体(anti-centromere antibody, ACA)与SSc患者并发ILD的关系，结果具有统计学意义[OR = 0.18, 95% CI (0.06, 0.53), P = 0.002]。(7) 共7篇文献研究了抗Scl-70抗体与SSc患者并发ILD的关系，结果具有统计学意义[OR = 2.60, 95% CI (1.66, 4.07), P < 0.0001]。结论：本次Meta分析结果显示，ACA是SSc患者发生ILD的保护性因素，dcSSc、PAH、ANA及抗Scl-70抗体是SSc患者发生ILD的危险因素。
Abstract: Objective: To explore the possible risk factors for interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) and provide basis for early detection and treatment of SSc-ILD. Methods: Search PubMed, EMBASE, Cochranelibrary and China National Knowledge Infrastructure based on the search terms, select all papers published before December 20, 2023, screen out the literature that meets the evaluation criteria, and use Revman5.4 software for data processing. Results: In the end, 7 articles were included, with a total of 1008 patients with SSc and 535 patients with SSc-ILD. This study explored a total of 7 possible risk factors. The meta-analysis results showed: (1) A total of 4 articles studied the relationship between cough and ILD in patients with SSc, and the results were not statistically significant [OR = 1.42, 95% CI (0.46, 4.39), P = 0.54]. (2) A total of 3 articles studied the relationship between cough and ILD in patients with SSc, and the results were [OR = 1.15, 95% CI (0.37, 3.54), P = 0.81]. (3) A total of 4 articles studied the relationship between the disease type dcSSc and the occurrence of ILD in SSc patients, and the results were statistically significant [OR = 3.18, 95% CI (2.19, 4.62), P < 0.00001]. (4) A total of 3 articles studied the relationship between pulmonary arterial hypertension (PAH) and the occurrence of ILD in SSc patients, and the results were statistically significant [OR = 5.60, 95% CI (2.57, 12.18), P < 0.0001]. (5) A total of 7 articles studied the relationship between anti-nuclear antibodies (ANA) and the occurrence of ILD in SSc patients, and the results were statistically significant [OR = 2.37, 95% CI (1.63, 3.45), P < 0.00001]. (6) A total of 4 articles studied the relationship between anti-centromereantibody (ACA) and ILD in SSc patients, and the results were statistically significant [OR = 0.18, 95% CI (0.06, 0.53), P = 0.002]. (7) A total of 7 articles studied the relationship between anti-Scl-70 antibody and ILD in SSc patients, and the results were statistically significant [OR = 2.60, 95% CI (1.66, 4.07), P < 0.0001]. Conclusion: The results of this meta-analysis show that ACA is a protective factor for ILD in SSc patients, and dcSSc, PAH, ANA and anti-Scl-70 antibody are risk factors for ILD in SSc patients.
文章引用：齐昕, 刘花香. 系统性硬化症并发间质性肺病危险因素的Meta分析[J]. 临床医学进展, 2024, 14(5): 2665-2673. https://doi.org/10.12677/acm.2024.1451733

参考文献

[1] Khanna, D., Tashkin, D.P., Denton, C.P., et al. (2020) Etiology, Risk Factors, and Biomarkers in Systemic Sclerosis with Interstitial Lung Disease. American Journal of Respiratory and Critical Care Medicine, 201, 650-660. [Google Scholar] [CrossRef] 
[2] Jung, E. (2018) Clinical Characteristics of Systemic Sclerosis with Interstitial Lung Disease. Archives of Rheumatology, 33, 322-327. [Google Scholar] [CrossRef] 
[3] Peoples, C., Medsger, T.A., Lucas, M., et al. (2016) Gender Differences in Systemic Sclerosis: Relationship to Clinical Features, Serologic Status and Outcomes. Journal of Scleroderma and Related Disorders, 1, 177-240. [Google Scholar] [CrossRef] [PubMed]
[4] Steen, V.D. and Medsger, T.A. (2007) Changes in Causes of Death in Systemic Sclerosis, 1972-2002. Annals of the Rheumatic Diseases, 66, 940-944. [Google Scholar] [CrossRef] [PubMed]
[5] Morrisroe, K., Stevens, W., Sahhar, J., et al. (2017) Epidemiology and Disease Characteristics of Systemic Sclerosis-Related Pulmonary Arterial Hypertension: Results from a Real-Life Screening Programme. Arthritis Research & Therapy, 19, 42. [Google Scholar] [CrossRef] [PubMed]
[6] Cappelli, S., Bellando Randone, S., Camiciottoli, G., et al. (2015) Interstitial Lung Disease in Systemic Sclerosis: Where Do We Stand? European Respiratory Review, 24, 411-419. [Google Scholar] [CrossRef] [PubMed]
[7] Kim, D.S., Yoo, B., Lee, J.S., et al. (2002) The Major Histopathologic Pattern of Pulmonary Fibrosis in Scleroderma Is Nonspecific Interstitial Pneumonia. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases, 19, 121-127.
[8] Silver, R.M. and Wells, A.U. (2008) Histopathology and Bronchoalveolar Lavage. Rheumatology, 47, v62-v64. [Google Scholar] [CrossRef] [PubMed]
[9] Molberg, Ø. and Hoffmann-Vold, A.-M. (2016) Interstitial Lung Disease in Systemic Sclerosis: Progress in Screening and Early Diagnosis. Current Opinion In Rheumatology, 28, 613-618. [Google Scholar] [CrossRef] 
[10] Cheng, J.Z., Wilcox, P.G., Glaspole, I., et al. (2017) Cough Is Less Common and Less Severe in Systemic Sclerosis-Associated Interstitial Lung Disease Compared to Other Fibrotic Interstitial Lung Diseases. Respirology, 22, 1592-1597. [Google Scholar] [CrossRef] [PubMed]
[11] 王琼. 系统性硬化症合并间质性肺病的临床分析[D]: [硕士学位论文]. 郑州: 郑州大学, 2019.
[12] 王顺兵, 郑建雄, 廖霞, 等. 系统性硬化症相关肺间质病变的临床特征及危险因素分析[J]. 四川医学, 2021, 42(9): 907-912. [Google Scholar] [CrossRef] 
[13] 陈欢. 126例系统性硬化症及其相关间质性肺病的回顾性分析[D]: [硕士学位论文]. 大理: 大理大学, 2023.[CrossRef] 
[14] 曹莹, 赵继军. 系统性硬化症的临床特征及合并间质性肺病的危险因素[J]. 广州医科大学学报, 2023, 51(4): 13-16.
[15] Ashmore, P., Tikly, M., Wong, M., et al. (2017) Interstitial Lung Disease in South Africans with Systemic Sclerosis. Rheumatology International, 38, 657-662. [Google Scholar] [CrossRef] [PubMed]
[16] Li, H., Zhang, X., Yu, L., et al. (2022) Comparing Clinical Characteristics of Systemic Sclerosis with or without Interstitial Lung Disease: A Cross-Sectional Study from a Single Center of the Chinese Rheumatism Data Center. Frontiers in Medicine, 9. [Google Scholar] [CrossRef] [PubMed]
[17] Liakouli, V., Ciancio, A., Del, Galdo, F., et al. (2023) Systemic Sclerosis Interstitial Lung Disease: Unmet Needs and Potential Solutions. Nature Reviews Rheumatology, 20, 21-32. [Google Scholar] [CrossRef] [PubMed]
[18] Van, Den, Hoogen, F., Khanna, D., Fransen, J., et al. (2013) 2013 Classification Criteria for Systemic Sclerosis: An American College of Rheumatology/European League against Rheumatism Collaborative Initiative. Annals of the Rheumatic Diseases, 72, 1747-1755.

为你推荐