METHODS: A literature search was conducted using PubMed and other databases from inception to June 2016. We abstracted data relating to anti-NR2A/B antibodies from the identified studies. The random effects model was used to calculate overall combined odds ratio (OD) with its corresponding 95% confidence interval (CI) to evaluate the relationship between anti-NR2A/B antibodies and NP syndromes in SLE and SS patients with and without NP events. We also included our own cohort of 57 SLE patients fulfilling the ACR 1997 revised classification criteria and 58 healthy controls (HCs).
RESULTS: In total, 17 studies with data on anti-NR2A/B antibodies in 2212 SLE patients, 66 SS patients, 99 disease controls (DCs) (e.g. antiphospholipid syndrome, myasthenia gravis and autoimmune polyendocrine syndrome I) and 538 HCs were used in this analysis. Overall pooled prevalence of serum/plasma anti-NR2A/B antibodies was higher in SLE patients [24.6% (95% CI 18.5-32.0%)] and SS patients [19.7% (95% CI 11.8-31.0%)] compared to DCs [14.8% (95% CI 2.2-56.9)] and HCs [7.6% (95% CI 4.6-12.4%)] (p=0.001). There was a significantly greater proportion of SLE and SS patients with NP syndromes who demonstrated positivity for serum/plasma anti-NR2A/B antibody [pooled OR=1.607 (95% CI 1.041-2.479), p=0.032] as compared to SLE and SS patients without NP syndromes in 13 studies. Usable data for cerebrospinal fluid anti-NR2A/B antibodies were available in only 4 studies [pooled OR=0.831 (95% CI 0.365-1.888), p=0.658]. Among the 19 NP syndromes, serum/plasma anti-NR2A/B antibodies were not specifically associated with any NP syndrome, including cognitive dysfunction (p=0.259) and mood disorder (p=0.503). Meta-regression identified proportion of anti-double-stranded deoxyribonucleic acid antibody positivity (p=0.009) and SLE Disease Activity Index (p=0.028) as moderators for the heterogeneity of serum/plasma anti-NR2A/B antibodies.
CONCLUSIONS: Circulating anti-NR2A/B antibody testing has a diagnostic value for NP syndromes in SLE and SS collectively. However, the evidence to date suggests that anti-NR2A/B antibody positivity cannot distinguish specific NP syndromes.
方法:从开始到2016年6月,使用PubMed和其他数据库进行了文献检索。我们从鉴定的研究中提取了与抗NR2A/B抗体相关的数据。随机效应模型用于计算总组合比值比(OD)及其相应的95%置信区间(CI),以评估有或没有NP事件的SLE和SS患者抗NR2A/B抗体与NP综合征之间的关系。我们还纳入了我们自己的57名符合ACR1997修订分类标准的SLE患者和58名健康对照(HCs)的队列。
结果:总计,关于2212例SLE患者的抗NR2A/B抗体的17项研究,66例SS患者,99个疾病对照(DC)(例如抗磷脂综合征,本分析使用重症肌无力和自身免疫性多内分泌综合征I)和538例HC。与DC[14.8%(95%CI2.2-56.9)]和HC[7.6%(95%CI4.6-12.4%)]相比,SLE患者[24.6%(95%CI18.5-32.0%)]和SS患者[19.7%(95%CI11.8-31.0%)]的血清/血浆抗NR2A/B抗体总体汇集患病率较高(p=0.001)。患有NP综合征的SLE和SS患者中,血清/血浆抗NR2A/B抗体阳性的比例明显更高[合并OR=1.607(95%CI1.041-2.479),与13项研究中没有NP综合征的SLE和SS患者相比,p=0.032]。脑脊液抗NR2A/B抗体的可用数据仅在4项研究中可用[合并OR=0.831(95%CI0.365-1.888),p=0.658]。在19个NP综合征中,血清/血浆抗NR2A/B抗体与任何NP综合征均无特异性相关,包括认知功能障碍(p=0.259)和情绪障碍(p=0.503)。Meta回归确定抗双链脱氧核糖核酸抗体阳性比例(p=0.009)和SLE疾病活动指数(p=0.028)作为血清/血浆抗NR2A/B抗体异质性的调节因子。
结论:循环抗NR2A/B抗体检测对SLE和SS共同的NP综合征具有诊断价值。然而,迄今为止的证据表明,抗NR2A/B抗体阳性不能区分特定的NP综合征.