Objectives To assess the association of antiphospholipid antibodies (aPL) and diffuse alveolar hemorrhage (DAH) in patients with systemic lupus erythematosus (SLE) by performing a systematic review and meta-analysis. Methods Multiple databases were systematically searched from inception to February 2024. Studies were eligible if they included patients with SLE (population), reported aPL status (exposure), and DAH (outcome). We pooled the estimates as odds ratio (OR) using fixed-effect models. We examined the association between aPL and DAH, as well as associations based on aPL subtypes or concomitant antiphospholipid syndrome (APS). Results Out of 454 screened studies, nine were included in meta-analysis, encompassing 7,746 patients with SLE, of whom 2016 (26.0%) were aPL positive and 163 (2.1%) had DAH. Patients with SLE and positive aPL (any) were more likely to develop DAH than aPL-negative patients (OR = 1.76, 95% CI 1.24–2.49; I2= 0%). Patients with SLE and positive lupus anticoagulant (LA; OR = 1.76, 95% CI 1.06–2.93, I2= 35%) or positive anticardiolipin IgG (OR = 1.62, 95% CI 1.13–2.34, I2=0%) had a higher likelihood of developing DAH compared with patients that were negative for these aPL. An APS diagnosis was associated with a 2.5-fold increased likelihood of DAH compared with subjects without APS (OR = 2.46, 95% CI 1.23–4.92, I2=0%). Positivity of anti-β2 glycoprotein I IgG was not significantly associated with DAH among patients with SLE (OR = 0.78, 95% CI 0.45–1.36, I2=0%). Conclusions In patients with SLE, aPL positivity increases the risk of DAH compared with aPL-negative patients, particularly in those positive for LA and anticardiolipin IgG.

中文翻译：

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系统性红斑狼疮抗磷脂抗体与弥漫性肺泡出血风险之间的关联：系统评价和荟萃分析


目的 通过系统评价和荟萃分析，评估系统性红斑狼疮 （SLE） 患者抗磷脂抗体 （aPL） 与弥漫性肺泡出血 （DAH） 的相关性。方法 系统检索了从建库到 2024 年 2 月的多个数据库。如果研究纳入了 SLE 患者 （人群） 、报告的 aPL 状态 （暴露） 和 DAH （结局），则研究符合条件。我们使用固定效应模型将估计值合并为比值比 （OR）。我们检查了 aPL 和 DAH 之间的关联，以及基于 aPL 亚型或伴随的抗磷脂综合征 （APS） 的关联。结果 在 454 项筛选研究中，9 项纳入荟萃分析，涉及 7,746 例 SLE 患者，其中 2016 例 （26.0%） 为 aPL 阳性，163 例 （2.1%） 为 DAH。与 aPL 阴性患者相比，aPL 阳性 （any） 的 SLE 患者更容易发生 DAH （OR = 1.76,95% CI 1.24-2.49;I2= 0%）。SLE 患者且狼疮抗凝物阳性 （LA;OR = 1.76,95% CI 1.06-2.93，I2= 35%） 或抗心磷脂 IgG 阳性 （OR = 1.62,95% CI 1.13-2.34，I2=0%） 与这些 aPL 阴性的患者相比，发生 DAH 的可能性更高。与没有 APS 的受试者相比，APS 诊断与 DAH 的可能性增加 2.5 倍相关 （OR = 2.46,95% CI 1.23-4.92，I2=0%）。在 SLE 患者中，抗 β2 糖蛋白 I IgG 阳性与 DAH 无显著相关性 （OR = 0.78,95% CI 0.45-1.36，I2=0%）。结论 在 SLE 患者中，与 aPL 阴性患者相比，aPL 阳性增加了 DAH 的风险，尤其是在 LA 和抗心磷脂 IgG 阳性的患者中。