目的:我们进行了系统评价和荟萃分析,以评估结缔组织病(CTD)相关间质性肺病(ILD)患者心血管疾病(CV)患病率是否增加,并验证相关危险因素。
方法:遵循PRISMA指南和PICO模型。我们搜索了PubMed,Embase,Cochrane图书馆数据库,Scopus,和开放存取期刊目录从开始到2024年4月。
结果:纳入13项研究,包括12,520名患者。与CTD患者相比,CTD-ILD患者发生CV疾病的风险显著增加(相对风险[RR]=1.65,95%置信区间[CI]:1.41,1.93),与男性比例(P=0.001)和吸烟者比例(P=0.045)有关。亚组分析发现CTD-ILD患者发生心力衰竭的风险较高(RR=2.84,95%CI:1.50,5.39),心律失常(RR=1.55,95%CI:1.22,1.97)比CTD患者多。另一个亚组分析显示RA-ILD和SSc-ILD与CV疾病的风险增加相关。但非IIM-ILD和MCTD-ILD(RA-ILD:RR=2.19,95%CI:1.27,3.80;SSc-ILD:RR=1.53,95%CI:1.29,1.82)。此外,CTD-ILD患者肺动脉高压的患病率高于CTD患者(RR=2.48,95%CI:1.69,3.63).
结论:CTD-ILD患者的CV风险是CTD-非ILD患者的1.65倍,心力衰竭和心律失常的患病率增加。SSc-ILD和RA-ILD患者发生CV疾病的风险增加,男性吸烟者应给予更多关注。此外,与CTD患者相比,CTD-ILD患者发生肺动脉高压的风险较高。
OBJECTIVE: We performed a systematic review and meta-analysis to assess whether patients with connective tissue disease (CTD)-associated interstitial lung diseases (
ILD) have an increased prevalence of cardiovascular (CV) disease and to validate associated risk factors.
METHODS: The PRISMA guidelines and PICO model were followed. We searched PubMed, Embase, Cochrane Library databases, Scopus, and Directory of Open Access Journals from inception to April 2024.
RESULTS: Thirteen studies comprising of 12,520 patients were included. Patients with CTD-ILD had a significantly increased risk of CV disease than patients with CTD (relative risk [RR] = 1.65, 95 % confidence interval [CI]: 1.41, 1.93), which are related to the proportion of men (P = 0.001) and the proportion of smokers (P = 0.045). Subgroup analysis found that patients with CTD-ILD had a higher risk of heart failure (RR = 2.84, 95 % CI: 1.50, 5.39), arrhythmia (RR = 1.55, 95 % CI: 1.22, 1.97) than patients with CTD. Another subgroup analysis showed that RA-
ILD and SSc-
ILD were associated with an increased risk of CV disease, but not IIM-
ILD and MCTD-
ILD (RA-
ILD: RR = 2.19, 95 % CI: 1.27, 3.80; SSc-
ILD: RR = 1.53, 95 % CI: 1.29, 1.82). Besides, patients with CTD-ILD had a higher prevalence of pulmonary arterial hypertension (RR = 2.48, 95 % CI: 1.69, 3.63) than patients with CTD.
CONCLUSIONS: Patients with CTD-ILD had a 1.65 times increased risk of CV than patients with CTD-non-
ILD, with increased prevalence of heart failure and arrhythmia. The risk of CV disease in SSc-
ILD and RA-
ILD is increased and we should pay more attention to male smokers. In addition, compared with CTD patients, CTD-ILD patients had a higher risk of pulmonary arterial hypertension.