| Objective:To explore the possible risk factors of pulmonary arterial hypertension(PAH)in patients with systemic sclerosis(SSc).In order to provide evidence-based medicine basis for early detection and early intervention of secondary PAH in SSc.Methods:The Chinese databases such as CNKI database,Wanfang database,VIP database and English databases such as pubmed,cochrane and embase were searched by computer,and the published case-control literatures about the risk factors of PAH in SSc from January 1,2000 to December 31,2019 were obtained.The literatures that met the evaluation criteria were selected and the data were analyzed by Revman 5.2 software.The publication bias was analyzed by Egger linear regression with Stata 11.0 software.Results:Finally,a total of 11 articles were included,including 407 cases in the cumulative case group(SSc with PAH)and 2307 cases in the control group(SSc without PAH).In this study,13 possible risk factors were discussed.Meta analysis showed that:(1)A total of 4 articles were included to discuss the relationship between pericardial effusion and secondary PAH of SSc,the results were statistically significant [OR=4.36,95%CI(2.93,6.49),P<0.00001];(2)A total of 8 literatures were included to discuss the relationship between pulmonary interstitial lesions and secondary PAH of SSc,the results were statistically significant [OR=1.95,95%CI(1.48,2.58),P<0.00001];(3)A total of 7 articleswere included to discuss the relationship between Raynaud phenomenon and secondary PAH of SSc,the results were statistically significant [OR=3.67,95%CI(2.16,6.23),P<0.00001];(4)A total of 7 articles were included to discuss the relationship between anti-RNP antibody positive and SSc secondary PAH,and the results were statistically significant [OR=3.59,95%CI(2.43,5.32),P<0.00001];(5)A total of 8 articles were included to discuss the relationship between anti-Scl-70 antibody positive and SSc secondary PAH,the results were statistically significant [OR=0.43,95%CI(0.30,0.62),P<0.00001];(6)A total of 8 articles were included to discuss the relationship between male and secondary PAH in SSc,the results were not statistically significant [OR=0.85,95%CI(0.61,1.19),P=0.35];(7)A total of 5 articles were included to discuss the relationship between Limited systemic sclerosis(LSSc)and SSc secondary PAH,the results were not statistically significant [OR=1.17,95%CI(0.87,1.58),P=0.30];(8)A total of 8 articles were included to discuss the relationship between the course of disease and secondary PAH of SSc,the results were statistically significant [SMD=0.35,95%CI(0.03,0.67),P=0.03];(9)A total of4 articles were included to discuss the relationship between the increase of serum IgA level and the secondary PAH of SSc,the results were statistically significant[SMD=0.48,95%CI(0.25,0.72),P<0.0001];(10)A total of 5 articles were included to discuss the relationship between the increase of serum IgG level and the secondary PAH of SSc,the results were not statistically significant [SMD=0.33,95%CI(-0.12,0.78),P=0.15];(11)A total of 4 articles were included to discuss the relationship between the increase of serum IgM level and the secondary PAH of SSc,the results were not statistically significant[SMD=0.00,95%CI(-0.54,0.54),P=0.99];(12)A total of 5 articles were included to discuss the relationship between the elevated level of ESR and the secondary PAH of SSc,the results were not statistically significant [SMD=0.21,95%CI(-0.17,0.59),P=0.28];(13)A total of 4 articles were included to discuss the relationship between the elevated level of C-reactive protein and secondary PAH in SSc,and the results were not statistically significant [SMD=0.50,95%CI(-0.04,1.03),P=0.07].Conclusion:(1)Long course of disease,pericardial effusion,pulmonary interstitial lesion,Raynaud phenomenon,high serum IgA level and positive anti-RNP antibody are risk factors for the occurrence of PAH in patients with SSc;(2)The positive anti-Scl-70 antibody is a protective factor for the occurrence of PAH in patients with SSc;(3)Male,LSSc,elevated levels of serum IgG,ESR and CRP are not related to the occurrence of PAH in patients with SSc. |
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