Semin Arthritis Rheu:孕期类风湿性关节炎改善的机制

2020-03-22 xiangting MedSci原创

尽管付出了巨大的努力,但妊娠引起RA改善的原因仍有待确定。妊娠各种短暂变化中的哪些引发了下游的抗炎免疫机制目前尚不清楚。

菲利普·汉奇(Philip Hench)于1938年首次报道了妊娠引起的类风湿性关节炎(RA)缓解现象。尽管做了很多努力,但其潜在科学基础仍不清楚。目前已经研究了很多不同的潜在机制。这项研究对涉及妊娠RA患者的现有同行评审文章进行了系统评价,以确定这一重要主题最新科学理解的深度。

根据系统评价和荟萃分析优先报告的条目指南进行了此项审查。全面检索包括Medline、PubMed和EMBASE在内的多个数据库来查找研究。使用的检索词是关键词的不同组合:类风湿性关节炎、炎症性关节炎、妊娠、机制、疾病活动性、复发和缓解。排除非英语文章和非直接相关的研究。两名独立的审阅者(CR和KA)通过阅读标题和摘要来筛选检索到的文章,以确定关于妊娠期RA活动性潜在机制的研究。阅读全文后,对文章进行进一步提炼。为了进行本次审查建立了数据提取表,以供独立审阅者使用。

在排除无关、重复和外语文章后,最终确定了37篇原始文章。涉及免疫球蛋白糖基化的文献最多,共9篇文章。有证据表明,免疫球蛋白的半乳糖基化水平升高与妊娠期RA疾病活动性降低之间存在关联。其他文章包括5篇关于妊娠中细胞因子的变化,5篇关于人白细胞抗原(HLA)不相容性,5篇关于外周血单核细胞(PBMC)基因表达变化的文章;4篇关于皮质类固醇的变化;3篇关于妊娠相关性α2-糖蛋白;2篇关于类风湿因子(RF)/抗瓜氨酸化蛋白抗体(ACPA)的变化;和关于微嵌合、γ-δT细胞、调节性T细胞和结合甘露糖的凝集素文章各1篇。这些研究的结果具有异质性,有时甚至是矛盾的。选定的研究在人群规模、方法、使用对照和疾病活动性评估方面差异很大。

这项系统评价发现,尽管付出了巨大的努力,但妊娠引起RA改善的原因仍有待确定。妊娠各种短暂变化中的哪些引发了下游的抗炎免疫机制目前尚不清楚。这项研究讨论了当前文献的局限性,并提出了未来研究的领域。

原始出处:

Dr Charles Raine. Mechanisms determining the amelioration of rheumatoid arthritis in pregnancy: A systematic review. Semin Arthritis Rheu.19 March 2020.

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    2020-03-24 lmm397
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    2020-03-24 zhaojie88
  5. [GetPortalCommentsPageByObjectIdResponse(id=1972712, encodeId=2b7019e271237, content=<a href='/topic/show?id=8a6a2e8839' target=_blank style='color:#2F92EE;'>#Arthritis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2788, encryptionId=8a6a2e8839, topicName=Arthritis)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Mon Nov 09 06:11:26 CST 2020, time=2020-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266137, encodeId=b4ab126613e34, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Tue Mar 24 05:11:26 CST 2020, time=2020-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334217, encodeId=92f5133421e1e, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Tue Mar 24 05:11:26 CST 2020, time=2020-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357446, encodeId=3f14135e446c1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Mar 24 05:11:26 CST 2020, time=2020-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483666, encodeId=95e61483666cc, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Tue Mar 24 05:11:26 CST 2020, time=2020-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=380846, encodeId=99e138084666, content=选择抗凝时机很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=44055313859, createdName=郭俊, createdTime=Sun Mar 22 21:07:40 CST 2020, time=2020-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1039211, encodeId=649f103921130, content=机制研究离临床仍然有距离,不过与临床结合思考,仍然有帮助的,不能仅仅是纯临床思维,转化思维同样重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿肿, createdTime=Sun Mar 22 17:11:26 CST 2020, time=2020-03-22, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1972712, encodeId=2b7019e271237, content=<a href='/topic/show?id=8a6a2e8839' target=_blank style='color:#2F92EE;'>#Arthritis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2788, encryptionId=8a6a2e8839, topicName=Arthritis)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Mon Nov 09 06:11:26 CST 2020, time=2020-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266137, encodeId=b4ab126613e34, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Tue Mar 24 05:11:26 CST 2020, time=2020-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334217, encodeId=92f5133421e1e, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Tue Mar 24 05:11:26 CST 2020, time=2020-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357446, encodeId=3f14135e446c1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Mar 24 05:11:26 CST 2020, time=2020-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483666, encodeId=95e61483666cc, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Tue Mar 24 05:11:26 CST 2020, time=2020-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=380846, encodeId=99e138084666, content=选择抗凝时机很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=44055313859, createdName=郭俊, createdTime=Sun Mar 22 21:07:40 CST 2020, time=2020-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1039211, encodeId=649f103921130, content=机制研究离临床仍然有距离,不过与临床结合思考,仍然有帮助的,不能仅仅是纯临床思维,转化思维同样重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿肿, createdTime=Sun Mar 22 17:11:26 CST 2020, time=2020-03-22, status=1, ipAttribution=)]
    2020-03-22 郭俊

    选择抗凝时机很关键

    0

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    2020-03-22 肿肿

    机制研究离临床仍然有距离,不过与临床结合思考,仍然有帮助的,不能仅仅是纯临床思维,转化思维同样重要

    0

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