系统性红斑狼疮脑病危险因素的Meta分析  

Meta-analysis of risk factors of neuropsychiatric systemic lupus erythematosus

作　　者：郭旭娟 刘秀梅 GUO Xu-Juan;LIU Xiu-Mei(The First Clinical Hospital of Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学第一临床医院

出　　处：《中国免疫学杂志》2020年第4期484-490,共7页Chinese Journal of Immunology

摘　　要：目的:通过Meta分析,探讨系统性红斑狼疮脑病发生的危险因素,更好地为临床上早期识别、预防及诊断该病提供循证医学依据。方法:检索PubMed、EMBASE、the Cochrane Library、知网、万方、中国科技期刊全文数据库,筛选系统性红斑狼疮脑病危险因素的相关文献,运用Revman 5.3软件对纳入的文献进行Meta分析。结果:最终纳入20篇符合要求的文献,总样本量4 067例,狼疮脑病的发生率为32.3%(1 314/4 067)。Meta分析各危险因素的合并OR值及95%CI分别为:WBC减少1.30(1.08~1.57),RBC减少1.58(0.95~2.64),PLT减少1.84(1.51~2.25),ALT升高3.47(2.34~5.16),AST升高3.82(2.61~5.60),盘状红斑0.45(0.30~0.67),蝶形红斑1.08(0.91~1.27),发热2.85(1.94~4.18),血管炎性皮损1.97(1.43~2.71),ESR增快2.45(1.76~3.40),低补体C3 2.10(1.66~2.65),低补体C4 2.70(2.14~3.39),抗ds-DNA抗体0.94(0.72~1.25),抗磷脂抗体2.05(1.72~2.46),抗SSA抗体0.80(0.67~0.96),抗SSB抗体0.84(0.65~1.07),抗Sm抗体1.14(0.92~1.42),抗ANA抗体1.14(0.81~1.61)。结论:①WBC减少、PLT减少、ALT升高、AST升高、发热、血管炎性皮损、ESR增快、低补体C3、C4、抗磷脂抗体阳性是狼疮脑病发生的重要危险因素;②盘状红斑、抗SSA抗体阳性是狼疮脑病的保护性因素;③RBC减少、蝶形红斑、抗ds-DNA抗体、抗SSB抗体、抗Sm抗体及抗ANA抗体则与狼疮脑病的发生无关。Objective:To analyze systematically the risk factors of neuropsychiatric systemic lupus erythematosus with the way of a Meta-analysis,and provides evidence-based evidence for clinical practice,which could provide better identification,prevention,and diagnosis for the disease.Methods:Relevant literatures of risk factors of neuropsychiatric systemic lupus erythematosus were searched from PubMed,EMBASE,the Cochrane Library,CNKI,Wanfang Database and Full-text Database of Chinese Sci-tech Journals.The Meta-analysis of the results was performed by Revman 5.3.Results:A total of 20 articles were included in this study,the total sample size was 4 067 cases,and the incidence of lupus encephalopathy was 32.3%(1 314/4 067).The combined OR values and 95%CI for each risk factor were:WBC reduced 1.30(1.08-1.57),RBC reduced 1.58(0.95-2.64),PLT reduced 1.84(1.51-2.25),ALT increased 3.47(2.34-5.16),AST increased 3.82(2.61-5.60),discoid erythema 0.45(0.30-0.67),butterfly erythema 1.08(0.91-1.27),fever 2.85(1.94-4.18),vasculitic skin lesion 1.97(1.43-2.71),ESR increased 2.45(1.76-3,40),abnormally decreased C3 level 2.10(1.66-2.65),abnormally decreased C4 level 2.70(2.14-3.39),anti-ds-DNA antibody(+)0.94(0.81-1.09),antiphospholipid antibody(+)2.05(1.72-2.46),anti-SSA antibody(+)0.80(0.67-0.96),anti-SSB antibody(+)0.84(0.65-1.07), anti-SM antibody(+)1.14(0.92-1.42),anti-ANA antibody(+)1.14(0.81-1.61).Conclusion:① WBC reduced,PLT reduced,ALT increased,AST increased,fever,vasculitic skin lesion,ESR increased,abnormally decreased C3and C4 level,antiphospholipid antibody positive are important risk factors of lupus encephalopathy.②Discoid erythema,anti-SSA antibody positive are protective factors of lupus encephalopathy.③ RBC,butterfly erythema,anti-ds-DNA antibody,anti-SSB antibody,anti-SM antibody,anti-ANA antibody are not related to the occurrence of lupus encephalopathy.

关 键 词：狼疮脑病 系统性红斑狼疮 危险因素 META分析 

分 类 号：R593.24+1[医药卫生—内科学]