背景:有很好的证据表明,特定的自身免疫性风湿性疾病(RD),例如,类风湿性关节炎和系统性红斑狼疮(SLE),与高凝状态和静脉血栓栓塞(VTE)风险增加相关。然而,对于其他自身免疫或自身炎症性RD,有关这种关联的信息有限.我们试图通过对D-二聚体之间的关联进行系统评价和荟萃分析来解决这个问题。确定的高凝状态和VTE的标志物,和RD以及介导这种关联的可能的临床和人口统计学因素。
方法:我们搜索了电子数据库PubMed,WebofScience,和Scopus从成立到2024年1月31日。使用JoannaBriggs研究所关键评估清单和等级评估了偏见的风险和证据的确定性,分别。
结果:在选择进行分析的31项研究中(2724例RD患者和3437例健康对照),与对照组相比,RD患者的d-二聚体浓度总体显着升高(标准平均差=0.93,95%CI0.76-1.10,p<.001;I2=86.1%,p<.001;证据的中等确定性)。敏感性分析结果稳定。观察到D-二聚体浓度组间差异的效应大小与年龄之间存在显着相关性,特定的RD和RD类别,RD持续时间,纤维蛋白原,纤溶酶原激活剂抑制剂,C反应蛋白,和红细胞沉降率。
结论:总体而言,与健康对照组相比,患有RD的患者的D-二聚体浓度明显更高,表明处于高凝状态。D-二聚体浓度的变化是由年龄介导的,特定的RD和RD类别,RD持续时间,抗凝和炎症标志物。有必要进行进一步的研究,以研究RD光谱中的d-二聚体浓度及其在预测和管理这些患者的VTE中的实用性(PROSPERO注册号:CRD42024517712)。
BACKGROUND: There is good evidence that specific autoimmune rheumatic diseases (RDs), for example, rheumatoid arthritis and systemic lupus erythematosus (SLE), are associated with a state of hypercoagulability and an increased risk of venous thromboembolism (VTE). However, limited information regarding this association is available for other autoimmune or autoinflammatory RDs. We sought to address this issue by conducting a systematic
review and meta-analysis of the association between the d-dimer, an established marker of hypercoagulability and VTE, and RDs and the possible clinical and demographic factors mediating this association.
METHODS: We searched the electronic databases PubMed, Web of Science, and Scopus from inception to January 31, 2024. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively.
RESULTS: In 31 studies selected for analysis (2724 RD patients and 3437 healthy controls), RD patients had overall significantly higher d-dimer concentrations when compared to controls (standard mean difference = 0.93, 95% CI 0.76-1.10, p < .001; I2 = 86.1%, p < .001; moderate certainty of evidence). The results were stable in a sensitivity analysis. Significant associations were observed between the effect size of the between-group differences in d-dimer concentration and age, specific RD and RD category, RD duration, fibrinogen, plasminogen activator inhibitor, C-reactive protein, and erythrocyte sedimentation rate.
CONCLUSIONS: Overall, patients with RDs have significantly higher d-dimer concentrations when compared with healthy controls, indicating a state of hypercoagulability. The alterations in d-dimer concentrations are mediated by age, specific RD and RD category, RD duration, and markers of anticoagulation and inflammation. Further research is warranted to investigate d-dimer concentrations across the spectrum of RDs and their utility in predicting and managing VTE in these patients (PROSPERO registration number: CRD42024517712).