The proportion of regulatory T cells in patients with ankylosing spondylitis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LAI Nalin , ZHANG Shengxiao , YAN Ming , CHENG Ting , MAO Xiaojuan ,  LI Xiaofeng

Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, P.R.China;

Corresponding author：

LI Xiaofeng, Email: 13753139859@163.com

Keywords：

Ankylosing spondylitis; Tregs; Meta-analysis; Systematic review; Case-control study

DOI：

10.7507/1672-2531.201902084

Video：

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Objectives To systematically review the proportion of Tregs in peripheral blood of patients with ankylosing spondylitis (AS) and its relationship with Treg's diffrent phenotypes.Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect case-control studies on peripheral Tregs of AS patients from inception to November 31^st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Stata 12.0 software.Results A total of 61 case-control studies involving 2 466 AS patients and 1 879 controls were included. The results of meta-analysis showed that: the proportion of peripheral Tregs of patients with AS was significantly lower than that of the normal control (SMD=−0.905, 95%CI −1.294 to −0.517, P<0.000 1), and the proportion of Tregs in the disease-active group was significantly lower than that in disease-inactive group (SMD=−0.928, 95%CI −1.431 to −0.425, P<0.000 1). The proportion of CD4⁺CD25⁺FOXP3⁺Tregs and CD4⁺CD25⁺CD127^low/−Tregs were lower in AS patients than that in control subjects (SMD=−2.547, 95%CI −3.521 to −1.573, P<0.000 1; SMD=−0.709, 95% CI −1.056 to −0.362, P<0.000 1). The proportion of Tregs defined by CD4⁺CD25^low/−FOXP3⁺ was higher in AS patients (SMD=0.683, 95%CI 0.161 to 1.206, P=0.01). There was no significant difference betweew other phenotypes of Tregs groups.roups.Conclusions The reduction of Tregs may be one of the important reasons for the occurrence and development of AS, which may provide a new approach for the diagnosis and treatment of AS.

Citation： LAI Nalin, ZHANG Shengxiao, YAN Ming, CHENG Ting, MAO Xiaojuan, LI Xiaofeng. The proportion of regulatory T cells in patients with ankylosing spondylitis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1170-1180. doi: 10.7507/1672-2531.201902084 Copy

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1. Braun J, Sieper J. Ankylosing spondylitis. Lancet, 2007, 369(9570): 1379-1390.
2. Dejaco C, Duftner C, Grubeck-Loebenstein B, et al. Imbalance of regulatory T cells in human autoimmune diseases. Immunology, 2006, 117(3): 289-300.
3. Guo H, Zheng M, Zhang K, et al. Functional defects in CD4⁺ CD25^high FoxP3⁺ regulatory cells in ankylosing spondylitis. Sci Rep, 2016, 6: 37559.
4. Bonelli M, Smolen JS, Scheinecker C. Treg and lupus. Ann Rheum Dis, 2010, 69(Suppl 1): i65-i66.
5. van der 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. Group OLoEW. The Oxford 20114 Levels of Evidence. Oxford: Centre for Evidence-Based Medicine, 2011.
7. Wells GA, Shea B, O'connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Oxford: 3rd Symposium on Systematic Reviews, 2000.
8. DerSimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials, 2007, 28(2): 105-114.
9. Cao D, van Vollenhoven R, Klareskog L, et al. CD25 bright CD4⁺ regulatory T cells are enriched in inflamed joints of patients with chronic rheumatic disease. Arthritis Res Ther, 2004, 6(4): R335-R346.
10. 陈丽娜. CD4⁺CD25(high) Treg 在类风湿关节炎不同病期和 TNF-α 受体抗体融合蛋白治疗中的消长及其意义的研究. 西安: 第四军医大学, 2007.
11. 郝慧琴, 黄烽, 邓小虎, 等. 抗肿瘤坏死因子-α 治疗对强直性脊柱炎患者外周血 CD4⁺CD25⁺T 细胞调节作用的初步研究. 中华风湿病学杂志, 2007, 11(6): 328-330.
12. Suen JL, Li HT, Jong YJ, et al. Altered homeostasis of CD4(+) FoxP3(+) regulatory T-cell subpopulations in systemic lupus erythematosus. Immunology, 2009, 127(2): 196-205.
13. 程昉, 严定安, 何东仪, 等. 强直性脊柱炎患者外周血 CD4⁺CD25⁺调节性 T 细胞的研究. 中华风湿病学杂志, 2008, 12(12): 808-811.
14. 章圣辉, 韩义香, 吴建波, 等. 强直性脊柱炎患者外周血 CD4⁺调节性 T 细胞的变化及意义. 中华微生物学和免疫学杂志, 2008, 28(5): 445-449.
15. Toussirot E, Saas P, Deschamps M, et al. Increased production of soluble CTLA-4 in patients with spondylarthropathies correlates with disease activity. Arthritis Res Ther, 2009, 11(4): R101.
16. Förger F, Villiger PM, Ostensen M. Pregnancy in patients with ankylosing spondylitis: do regulatory T cells play a role? Arthritis Rheum, 2009, 61(2): 279-283.
17. 黄河, 汪亚东, 孙燕燕, 等. 强直性脊柱炎患者外周血中调节性 T 细胞水平研究. 中国热带医学, 2009, 9(10): 1992-1993.
18. Ciccia F, Accardo-Palumbo A, Giardina A, et al. Expansion of intestinal CD4⁺CD25(high) Treg cells in patients with ankylosing spondylitis: a putative role for interleukin-10 in preventing intestinal Th17 response. Arthritis Rheum, 2010, 62(12): 3625-3634.
19. Dejaco C, Duftner C, Klauser A, et al. Altered T-cell subtypes in spondyloarthritis, rheumatoid arthritis and polymyalgia rheumatica. Rheumatol Int, 2010, 30(3): 297-303.
20. 李秀娟, 黄胜起, 李时英, 等. 强直性脊柱炎患者外周血 CD4⁺CD25^+high 调节性 T 细胞的表达及其与传统指标相关性研究. 医学研究杂志, 2010, 39(11): 47-49.
21. 王朋. HLA-B27 阳性者中 CD4⁺CD25(bright) Treg 细胞的检测及意义. 实验与检验医学, 2010, 28(6): 579-580.
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Chinese Journal of Evidence-Based Medicine

The proportion of regulatory T cells in patients with ankylosing spondylitis: a meta-analysis

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