Diagnostic Value of HLA-B27 for Ankylosing Spondylitis in China: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 AIJin-wei ^1,2 , LIDe-sheng ² , LIUYu ² , LINHong-ming ² , WANGQian ² ,  PEIBin ^1,2

1. Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, China;
2. Department of Orthopedic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, China;

Corresponding author：

PEIBin, Email: xyxzyxzx@163.com

Keywords：

HLA-B27; Ankylosing spondylitis; Diagnostic test; Meta-analysis; Chinese

DOI：

10.7507/1672-2531.20150176

Video：

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Objective To systematically review the diagnostic value of HLA-B27 for ankylosing spondylitis (AS) in China. Methods We searched PubMed, The Cochrane Library (Issue 4, 2015), EMbase, CNKI, CBM, VIP and WanFang data from inception to April 2015, to collect diagnostic studies about HLA-B27 for AS in China. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then meta-analysis was performed using Meta-Disc 1.4 software. Pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR), and area under the curve (AUC) of summary receiver operating characteristic curve (SROC) were calculated to assess the diagnostic value of individual diagnostic tests. Subgroup analysis was stratified by detection methods of HLA-B27. Results A total of 18 studies involving 22 comparisons, with 3 670 AS patients and 28 389 health controls were finally included. The results of meta-analysis showed that the pooled Sen, Spe, +LR,-LR, and DOR were 0.92 (95%CI 0.90 to 0.93), 0.94 (95%CI 0.94 to 0.95), 16.22 (95%CI 13.63 to 19.29), 0.08 (95%CI 0.06 to 0.10), and 256.49 (95%CI 168.25 to 391.00), respectively. The AUC of SROC was 0.98. The result of subgroup analysis showed that there was no significant difference for flow cytometry (FCM) and Polymerase Chain Reaction with Sequence-Specific Primer (PCR-SSP) in HLA-B27 detection for AS (Z=7.915, P=0.960). Conclusion Current evidence indicates that HLA-B27 detection is of great diagnostic value for AS. At present, FCM and PCR-SSP shows no significant difference in HLA-B27 detection for AS. Due to the limitation of the quality of included studies, and the exclusion of the suspected patients, higher quality studies are needed to verify the above conclusion.

Citation： AIJin-wei, LIDe-sheng, LIUYu, LINHong-ming, WANGQian, PEIBin. Diagnostic Value of HLA-B27 for Ankylosing Spondylitis in China: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(9): 1059-1067. doi: 10.7507/1672-2531.20150176 Copy

1.	Smith JA. Update on Ankylosing Spondylitis:Current Concepts in Pathogenesis. Curr Allergy Asthma Rep, 2015, 15(1):481-489.
2.	Wendling D, Lukas C, Paccou J, et al. Recommendations of the French Society for Rheumatology (SFR) on the everyday management of patients with spondyloarthritis. Joint Bone Spine, 2014, 81(1):6-14.
3.	Dougados M, Paternotte S, Braun J, et al. ASAS recommendations for collecting, analysing and reporting NSAID intake in clinical trials/epidemiological studies in axial spondyloarthritis. Ann Rheum Dis, 2011, 70(2):249-251.
4.	黎勤云, 李志强. 强直性脊柱炎相关HLA-B27的研究进展. 中国输血杂志, 2012, 25(11):1138-1140.
5.	Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum, 1984, 27(4):361-368.
6.	Rachid B, Zorkany B, Youseif E, et al. Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle East. Clin Rheumatol, 2012, 31(11):1633-1639.
7.	Browerton D, Hart F, Nichous N, et al. Ankylosing spondylitis and HLA-B27. Lancet, 1973, 8(1):904-907.
8.	Zochling J, Khan MA, Kvien TK, et al. ASAS/EULAR recommen-dations for the management of ankylosing spondylitis. Ann Rheum Dis, 2006, 65(4):442-452.
9.	Popa OM, Bojinca M, Bojinca V, et al. Distribution of HLA-B27 in Romanian spondyloarthritides patients. Int J Immunopharmacol, 2010, 37(6):513-516.
10.	Acar M, Cora T, Tunc R, et al. HLA-B27 subtypes in Turkish patients with ankylosing spondylitis and healthy controls. Rheumatol Int, 2012, 32(10):3103-3105.
11.	Rachid B, Bassel Z, Youseif E, et al. Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle East. Clin Rheumatol, 2012, 31(11):1633-1639.
12.	尹森林, 刘雪梅, 何林, 等. 对系统评价/Meta分析报告规范的系统评价. 中国循证医学杂志, 2011, 11(8):971-977.
13.	张俊, 徐志伟, 李克. 诊断性试验Meta分析的效应指标评价. 中国循证医学杂志, 2013, 13(7):890-895.
14.	蒋娟, 熊小敏, 张卫云, 等. 人白细胞抗原HLA-B27在强直性脊柱炎中的临床意义. 生物技术通讯, 2014, 25(3):410-411.
15.	彭萍, 张浩, 谢丽华. 聚合酶链式反应SSP法和酶联免疫性脊柱炎患者HLA_B27的比较. 工企医刊, 2014, 3:800-801.
16.	于莉. PCR-SSP法、FCM法及MLCT法检测强直性脊柱炎患者HLA-B27对比分析. 风湿病与关节炎, 2014, 10(3):13-15.
17.	秦学军. 人类白细胞抗原B27和免疫指标在强直性脊柱炎诊断中的应用. 实用临床医药杂志, 2013,17(15):87-89.
18.	张小芳, 张运刚, 李守霞, 等. HLA-B27 与强直性脊柱炎的相关性研究. 中国现代医学杂志, 2013, 23(36):56-59.
19.	鱼惠霞, 鱼云霞, 朱彩侠, 等. 强直性脊柱炎患者HLA-B27抗原表达与临床的相关性分析. 宁夏医学杂志, 2013, 35(10):901-903.
20.	吴娟. 检测强直性脊柱炎患者人类白细胞抗原B27的临床意义. 检验医学与临床, 2013, 10(6):663-665.
21.	惠丽红. 强直性脊炎证型与HLA-B27的检验价值. 亚太传统医药, 2013, 9(9):196-197.
22.	赵晓君, 薛鸾, 陈云飞, 等. 三种方法检测强直性脊柱炎患者HLA-B27的效果比较. 山东医药, 2011, 51(43):48-49.
23.	李慧琰. PCR-SSP法与微量淋巴细胞毒试验检测强直性脊柱炎患者HLA-B27的比较. 医药论坛杂志, 2010, 31(5):78-79.
24.	胡庆宏, 易诚予, 彭燕, 等. 江西地区强直性脊柱炎与HLA-B27基因关联性. 中国组织工程研究与临床康复, 2009, 13(46):9183-9186.
25.	陈志坚, 李山. 广西壮族强直性脊柱炎患者HLA-B27的检测. 广西医科大学学报, 2007, 24(6):928-929.
26.	陈志坚, 李山. 强直性脊柱炎患者 HLA-B27的检测. 华中医学杂志, 2004, 28(1):13-14.
27.	Lin J, Lu H, Chuanhan F. Ankylosing spondylitis and heterogeneity of HLA B27 in Chinese. CMJ, 1996, 109(4):313-316.
28.	Liu X, Li Y, Hu L, et al. High frequencies of HLA-B27 in Chinese patients with suspected of ankylosing spondylitis. Rheumatol Int, 2010, 30(10):1305-1309.
29.	Qi J, Li Q, Lin Z, et al. Higher risk of uveitis and dactylitis and older age of onset among ankylosing spondylitis patients with HLA-B2705 than patients with HLA-B2704 in the Chinese population. Tissue Antigens, 2013, 82(6):380-386.
30.	Qian B, Jiang J, Ji M, et al. Lack of associations between two previously identified susceptible single nucleotide polymorphisms of interleukin-23 receptor gene and ankylosing spondylitis:a replication study in a Chinese Han population. BMC musculoskelet disord, 2013, 14(1):190-198.
31.	Chen I, Yang K, Lee A, et al. Low frequency of HLA-B*2706 in Taiwanese patients with Blackwell Science, Ltd ankylosing spondylitis. Eur J Immunogenet, 2002(5):435-438.
32.	祝文彩, 陈建平, 杨曙梅, 等. 强直性脊柱炎患者HLA-B27、CRP和ESR的水平及相关性分析. 中国实验诊断学, 2013, 17(11):2016-2018.

1. Smith JA. Update on Ankylosing Spondylitis:Current Concepts in Pathogenesis. Curr Allergy Asthma Rep, 2015, 15(1):481-489.
2. Wendling D, Lukas C, Paccou J, et al. Recommendations of the French Society for Rheumatology (SFR) on the everyday management of patients with spondyloarthritis. Joint Bone Spine, 2014, 81(1):6-14.
3. Dougados M, Paternotte S, Braun J, et al. ASAS recommendations for collecting, analysing and reporting NSAID intake in clinical trials/epidemiological studies in axial spondyloarthritis. Ann Rheum Dis, 2011, 70(2):249-251.
4. 黎勤云, 李志强. 强直性脊柱炎相关HLA-B27的研究进展. 中国输血杂志, 2012, 25(11):1138-1140.
5. Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum, 1984, 27(4):361-368.
6. Rachid B, Zorkany B, Youseif E, et al. Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle East. Clin Rheumatol, 2012, 31(11):1633-1639.
7. Browerton D, Hart F, Nichous N, et al. Ankylosing spondylitis and HLA-B27. Lancet, 1973, 8(1):904-907.
8. Zochling J, Khan MA, Kvien TK, et al. ASAS/EULAR recommen-dations for the management of ankylosing spondylitis. Ann Rheum Dis, 2006, 65(4):442-452.
9. Popa OM, Bojinca M, Bojinca V, et al. Distribution of HLA-B27 in Romanian spondyloarthritides patients. Int J Immunopharmacol, 2010, 37(6):513-516.
10. Acar M, Cora T, Tunc R, et al. HLA-B27 subtypes in Turkish patients with ankylosing spondylitis and healthy controls. Rheumatol Int, 2012, 32(10):3103-3105.
11. Rachid B, Bassel Z, Youseif E, et al. Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle East. Clin Rheumatol, 2012, 31(11):1633-1639.
12. 尹森林, 刘雪梅, 何林, 等. 对系统评价/Meta分析报告规范的系统评价. 中国循证医学杂志, 2011, 11(8):971-977.
13. 张俊, 徐志伟, 李克. 诊断性试验Meta分析的效应指标评价. 中国循证医学杂志, 2013, 13(7):890-895.
14. 蒋娟, 熊小敏, 张卫云, 等. 人白细胞抗原HLA-B27在强直性脊柱炎中的临床意义. 生物技术通讯, 2014, 25(3):410-411.
15. 彭萍, 张浩, 谢丽华. 聚合酶链式反应SSP法和酶联免疫性脊柱炎患者HLA_B27的比较. 工企医刊, 2014, 3:800-801.
16. 于莉. PCR-SSP法、FCM法及MLCT法检测强直性脊柱炎患者HLA-B27对比分析. 风湿病与关节炎, 2014, 10(3):13-15.
17. 秦学军. 人类白细胞抗原B27和免疫指标在强直性脊柱炎诊断中的应用. 实用临床医药杂志, 2013,17(15):87-89.
18. 张小芳, 张运刚, 李守霞, 等. HLA-B27 与强直性脊柱炎的相关性研究. 中国现代医学杂志, 2013, 23(36):56-59.
19. 鱼惠霞, 鱼云霞, 朱彩侠, 等. 强直性脊柱炎患者HLA-B27抗原表达与临床的相关性分析. 宁夏医学杂志, 2013, 35(10):901-903.
20. 吴娟. 检测强直性脊柱炎患者人类白细胞抗原B27的临床意义. 检验医学与临床, 2013, 10(6):663-665.
21. 惠丽红. 强直性脊炎证型与HLA-B27的检验价值. 亚太传统医药, 2013, 9(9):196-197.
22. 赵晓君, 薛鸾, 陈云飞, 等. 三种方法检测强直性脊柱炎患者HLA-B27的效果比较. 山东医药, 2011, 51(43):48-49.
23. 李慧琰. PCR-SSP法与微量淋巴细胞毒试验检测强直性脊柱炎患者HLA-B27的比较. 医药论坛杂志, 2010, 31(5):78-79.
24. 胡庆宏, 易诚予, 彭燕, 等. 江西地区强直性脊柱炎与HLA-B27基因关联性. 中国组织工程研究与临床康复, 2009, 13(46):9183-9186.
25. 陈志坚, 李山. 广西壮族强直性脊柱炎患者HLA-B27的检测. 广西医科大学学报, 2007, 24(6):928-929.
26. 陈志坚, 李山. 强直性脊柱炎患者 HLA-B27的检测. 华中医学杂志, 2004, 28(1):13-14.
27. Lin J, Lu H, Chuanhan F. Ankylosing spondylitis and heterogeneity of HLA B27 in Chinese. CMJ, 1996, 109(4):313-316.
28. Liu X, Li Y, Hu L, et al. High frequencies of HLA-B27 in Chinese patients with suspected of ankylosing spondylitis. Rheumatol Int, 2010, 30(10):1305-1309.
29. Qi J, Li Q, Lin Z, et al. Higher risk of uveitis and dactylitis and older age of onset among ankylosing spondylitis patients with HLA-B*2705 than patients with HLA-B*2704 in the Chinese population. Tissue Antigens, 2013, 82(6):380-386.
30. Qian B, Jiang J, Ji M, et al. Lack of associations between two previously identified susceptible single nucleotide polymorphisms of interleukin-23 receptor gene and ankylosing spondylitis:a replication study in a Chinese Han population. BMC musculoskelet disord, 2013, 14(1):190-198.
31. Chen I, Yang K, Lee A, et al. Low frequency of HLA-B*2706 in Taiwanese patients with Blackwell Science, Ltd ankylosing spondylitis. Eur J Immunogenet, 2002(5):435-438.
32. 祝文彩, 陈建平, 杨曙梅, 等. 强直性脊柱炎患者HLA-B27、CRP和ESR的水平及相关性分析. 中国实验诊断学, 2013, 17(11):2016-2018.

Chinese Journal of Evidence-Based Medicine

Diagnostic Value of HLA-B27 for Ankylosing Spondylitis in China: A Meta-analysis

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