[摘要] 目的 系统评估类风湿关节炎（rheumatoid arthritis，RA）患者中奇异变形杆菌（proteus mirabilis，PM）的感染水平，并探讨其与RA发病的潜在关联。方法 依据流行病学观察性研究的Meta分析及系统评价和Meta分析的首选报告条目指南，在PubMed、Web of Science和Embase数据库中进行全面检索，筛选时间截至2024年12月，纳入比较RA患者与健康对照者抗PM抗体水平的相关研究，采用纽卡斯尔–渥太华量表评估纳入研究的质量。通过Q检验和I²检验评估研究间的异质性，并据此选择固定效应或随机效应模型，通过敏感度分析、Begg检验及剪补法评估结果的稳健性。结果 最终纳入18篇符合标准的文献，涉及753例RA患者和716名健康对照者，RA患者的总抗体水平[加权均数差（weighted mean difference，WMD）=0.86，95%CI：0.38～1.34，I²=98.3%，P=0.000]和免疫球蛋白A抗体水平（WMD=0.17，95%CI：0.06～0.28，I²=96.7%，P=0.000）均高于健康对照者，亚组分析显示地域和检测方法中存在显著异质性。结论 防治PM感染可能成为RA管理的补充策略且在一定程度上为“PM抗原–泌尿生殖道黏膜–自身免疫”的病理假说提供循证依据。

[关键词] 类风湿关节炎；奇异变形杆菌；对照研究；尿路感染

[中图分类号] R593.22" """"[文献标识码] A """""[DOI] 10.3969/j.issn.1673-9701.2025.18.005

Epidemiologic evidence of proteus mirabilis infection in patients with rheumatoid arthritis： A systematic evaluation and Meta-analysis of included global controlled studies

ZHANG Jiawei¹， JI Li²， DING Guoyong³， LIU Shuman⁴， WU Mengyun¹， ZHANG Xue¹， ZHOU Aihong¹

1.Department of Rheumatology and Immunology， the Second Affiliated Hospital of Shandong First Medical University， Tai’an 271000， Shandong， China; 2.Department of Critical Care Medicine， Tai’an Central Hospital Affiliated to Qingdao University， Tai’an 271000， Shandong， China; 3.Shandong First Medical University， Shandong Academy of Medical Sciences School of Public Health and Health Management， Jinan 250117， Shandong， China; 4.Department of Rheumatology and Immunology， Nanjing Gulou Hospital， Nanjing 210008， Jiangsu， China

[Abstract] Objective To systematically evaluate the level of proteus mirabilis （PM） infection in patients with rheumatoid arthritis （RA） and to investigate its potential association with the development of RA. Methods Based on Meta-analysis of observational studies in epidemiology and preferred reporting items for systematic review and Meta-analysis guide， a comprehensive search of PubMed， Web of Science and Embase databases was conducted to screen relevant literature published up to December 2024 for studies comparing the levels of anti-PM antibodies between RA patients and healthy populations， and the quality of the included studies was assessed by using the Newcastle-Ottawa scale. Heterogeneity among studies was assessed by Q-test and I²-test， and accordingly， fixed-effects or random-effects models were selected， and the robustness of the results was assessed by sensitivity analyses， Begg’s test， and clipping and patching method. Results Finally， 18 eligible articles were included， involving 753 RA patients and 716 healthy controls. The total antibody levels [weighted mean difference （WMD）=0.86， 95%CI： 0.38-1.34， I²=98.3%， P=0.000] and IgA antibody levels （WMD=0.17， 95%CI： 0.06-0.28， I²=96.7%， P=0.000） of RA patients were higher than those of healthy controls， and subgroup analyses revealed significant heterogeneity among geographic regions and testing methods. Conclusion Prevention and treatment of PM infections may be a complementary strategy for RA management and provide evidence-based support for the “PM antigen-genitourinary tract mucosa-autoimmunity” pathology hypothesis.

[Key words] Rheumatoid arthritis; Proteus mirabilis; Controlled studies; Urinary tract infections

类风湿关节炎（rheumatoid arthritis，RA）是一种以慢性滑膜炎症为特征的自身免疫性疾病，典型症状包括关节疼痛、晨僵及功能障碍^[1]。尽管RA的确切发病机制尚未完全阐明，但现有研究普遍支持感染因素在其发生发展中起关键作用^[2-3]。研究显示RA患者尿路感染（urinary tract infection，UTI）发病率较健康人群显著升高（2～9倍）^[4]；且奇异变形杆菌（proteus mirabilis，PM）作为复杂性UTI及菌血症的主要病原体，可能通过分子模拟等机制参与RA病理进程^[5-7]。目前关于RA群体中PM感染的真实流行率仍缺乏直观且高等级的可信证据。……