背景:可靠的内皮激活生物标志物的可用性可能增强类风湿性关节炎(RA)亚临床动脉粥样硬化的识别。我们通过对RA患者的细胞粘附分子进行系统评价和荟萃分析来研究这个问题。
方法:我们在电子数据库中搜索了从开始到2023年7月31日的病例对照研究,以评估免疫球蛋白样粘附分子的循环浓度(血管细胞,VCAM-1,细胞间,ICAM-1和血小板内皮细胞,PECAM-1,粘附分子-1)和选择素(E,L,和P选择素)在RA患者和健康对照中。使用JBI核对表和等级评估偏倚风险和证据的确定性,分别。
结果:在39项研究中,与对照组相比,RA患者的ICAM-1浓度明显较高(标准平均差,SMD=0.81,95%CI0.62-1.00,p<0.001;I2=83.0%,p<0.001),VCAM-1(SMD=1.17,95%CI0.73-1.61,p<0.001;I2=95.8%,p<0.001),PECAM-1(SMD=0.82,95%CI0.57-1.08,p<0.001;I2=0.0%,p=0.90),E-选择素(SMD=0.64,95%CI0.42-0.86,p<0.001;I2=75.0%,p<0.001),和P-选择素(SMD=1.06,95%CI0.50-1.60,p<0.001;I2=84.8%,p<0.001),但不是L-选择素.在荟萃回归和亚组分析中,观察到疗效大小与糖皮质激素(ICAM-1)的使用之间存在显着相关性,红细胞沉降率(VCAM-1),研究大陆(VCAM-1,E-选择素,和P-选择素),和矩阵评估(P-选择素)。
结论:我们的研究结果支持细胞粘附分子在介导RA和动脉粥样硬化之间的相互作用中的重要作用。需要进一步的研究来确定这些生物标志物的常规使用是否可以促进该患者组中早期动脉粥样硬化的检测和管理。PROSPERO注册号:CRD42023466662。
BACKGROUND: The availability of robust biomarkers of endothelial activation might enhance the identification of subclinical atherosclerosis in rheumatoid arthritis (RA). We investigated this issue by conducting a systematic review and meta-analysis of cell adhesion molecules in RA patients.
METHODS: We searched electronic databases from inception to 31 July 2023 for case-control studies assessing the circulating concentrations of immunoglobulin-like adhesion molecules (vascular cell, VCAM-1, intercellular, ICAM-1, and platelet endothelial cell, PECAM-1, adhesion molecule-1) and
selectins (E, L, and P selectin) in RA patients and healthy controls. Risk of bias and certainty of evidence were assessed using the JBI checklist and GRADE, respectively.
RESULTS: In 39 studies, compared to controls, RA patients had significantly higher concentrations of ICAM-1 (standard mean difference, SMD = 0.81, 95% CI 0.62-1.00, p < 0.001; I2 = 83.0%, p < 0.001), VCAM-1 (SMD = 1.17, 95% CI 0.73-1.61, p < 0.001; I2 = 95.8%, p < 0.001), PECAM-1 (SMD = 0.82, 95% CI 0.57-1.08, p < 0.001; I2 = 0.0%, p = 0.90), E-selectin (SMD = 0.64, 95% CI 0.42-0.86, p < 0.001; I2 = 75.0%, p < 0.001), and P-selectin (SMD = 1.06, 95% CI 0.50-1.60, p < 0.001; I2 = 84.8%, p < 0.001), but not L-selectin. In meta-regression and subgroup analysis, significant associations were observed between the effect size and use of glucocorticoids (ICAM-1), erythrocyte sedimentation rate (VCAM-1), study continent (VCAM-1, E-selectin, and P-selectin), and matrix assessed (P-selectin).
CONCLUSIONS: The results of our study support a significant role of cell adhesion molecules in mediating the interplay between RA and atherosclerosis. Further studies are warranted to determine whether the routine use of these biomarkers can facilitate the detection and management of early atherosclerosis in this patient group. PROSPERO Registration Number: CRD42023466662.