A systematic review and meta-analysis of cutaneous manifestations in late- versus early-onset systemic lupus erythematosus.
A systematic review and meta-analysis of cutaneous manifestations in late- versus early-onset systemic lupus erythematosus.
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DOI：
10.1016/j.semarthrit.2016.01.004
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发表时间：
2016-06
影响因子：
5
通讯作者：
Bartels CM
中科院分区：
文献类型：
--
作者：
Medlin JL;Hansen KE;Fitz SR;Bartels CM
虽然系统性红斑狼疮（SLE）最常见于育龄妇女，但有些人在50岁后被诊断出来。认识到超过三分之一的SLE标准是皮肤，我们进行了系统的审查和荟萃分析，以评估早期和晚发性SLE患者的皮肤表现的差异。我们使用PubMed、CINAHL、Web of Science和科克伦图书馆进行文献检索。我们排除了不包括ACR SLE分类标准的研究，早发性对照，晚发性SLE定义为<50岁，或者不是用英语写的。两位作者使用纽卡斯尔渥太华质量量表对研究质量进行了评级。我们使用森林图来比较不同年龄皮肤表现的比值比（95%置信区间）。使用I2评估研究异质性。35项研究，代表11，189例早发性和1，727例晚发性SLE患者，符合资格标准。晚发型组的女性：男性比例较低（5：1 vs 8：1）。大多数皮肤表现在晚发型组中不太普遍。特别是，颧骨皮疹（OR 0.43（0.35，0.52））、光敏性（OR 0.72（0.59，0.88））和网状青斑（OR 0.33（0.17，0.64））在晚发型患者中较不常见。与此相反，干燥症状更常见（OR 2.45（1.91，3.14））。平均纽卡斯尔渥太华质量量表评分为6.3 ±0.5（量表0-9），评分者间信度较高（0.96）。总体而言，皮肤表现是不常见的晚发性SLE患者，干燥症状除外。未来的研究应探讨这一现象的病因，包括免疫衰老，环境，性别和免疫遗传学的作用。
Although systemic lupus erythematosus (SLE) most commonly occurs in reproductive-age women, some are diagnosed after age 50. Recognizing that greater than one third of SLE criteria are cutaneous, we undertook a systematic review and meta-analysis to evaluate differences in cutaneous manifestations in early and late-onset SLE patients. We searched the literature using PubMed, CINAHL, Web of Science and Cochrane Library. We excluded studies that did not include ACR SLE classification criteria, early-onset controls, that defined late-onset SLE as <50 years of age, or were not written in English. Two authors rated study quality using the Newcastle Ottawa Quality Scale. We used Forest plots to compare odds ratios (95% confidence intervals) of cutaneous manifestations by age. Study heterogeneity was assessed using I2. Thirty five studies, representing 11,189 early-onset and 1,727 late-onset patients with SLE, met eligibility criteria. The female: male ratio was lower in the late-onset group (5:1 versus 8:1). Most cutaneous manifestations were less prevalent in the late-onset group. In particular, malar rash (OR 0.43 (0.35, 0.52)), photosensitivity (OR 0.72 (0.59, 0.88)) and livedo reticularis (OR 0.33 (0.17, 0.64)) were less common in late-onset patients. In contrast, sicca symptoms were more common (OR 2.45 (1.91, 3.14)). The mean Newcastle Ottawa Quality Scale score was 6.3 ±0.5 (scale 0–9) with high inter-rater reliability for the score (0.96). Overall, cutaneous manifestations are less common in late-onset SLE patients, except sicca symptoms. Future studies should investigate etiologies for this phenomenon including roles of immune senescence, environment, gender and immunogenetics.