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

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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, 李志強. 強直性脊柱炎相關HLA-B27的研究進展. 中國輸血雜志, 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, 劉雪梅, 何林, 等. 對系統評價/Meta分析報告規范的系統評價. 中國循證醫學雜志, 2011, 11(8):971-977.
13.	張俊, 徐志偉, 李克. 診斷性試驗Meta分析的效應指標評價. 中國循證醫學雜志, 2013, 13(7):890-895.
14.	蔣娟, 熊小敏, 張衛云, 等. 人白細胞抗原HLA-B27在強直性脊柱炎中的臨床意義. 生物技術通訊, 2014, 25(3):410-411.
15.	彭萍, 張浩, 謝麗華. 聚合酶鏈式反應SSP法和酶聯免疫性脊柱炎患者HLA_B27的比較. 工企醫刊, 2014, 3:800-801.
16.	于莉. PCR-SSP法、FCM法及MLCT法檢測強直性脊柱炎患者HLA-B27對比分析. 風濕病與關節炎, 2014, 10(3):13-15.
17.	秦學軍. 人類白細胞抗原B27和免疫指標在強直性脊柱炎診斷中的應用. 實用臨床醫藥雜志, 2013,17(15):87-89.
18.	張小芳, 張運剛, 李守霞, 等. HLA-B27 與強直性脊柱炎的相關性研究. 中國現代醫學雜志, 2013, 23(36):56-59.
19.	魚惠霞, 魚云霞, 朱彩俠, 等. 強直性脊柱炎患者HLA-B27抗原表達與臨床的相關性分析. 寧夏醫學雜志, 2013, 35(10):901-903.
20.	吳娟. 檢測強直性脊柱炎患者人類白細胞抗原B27的臨床意義. 檢驗醫學與臨床, 2013, 10(6):663-665.
21.	惠麗紅. 強直性脊炎證型與HLA-B27的檢驗價值. 亞太傳統醫藥, 2013, 9(9):196-197.
22.	趙曉君, 薛鸞, 陳云飛, 等. 三種方法檢測強直性脊柱炎患者HLA-B27的效果比較. 山東醫藥, 2011, 51(43):48-49.
23.	李慧琰. PCR-SSP法與微量淋巴細胞毒試驗檢測強直性脊柱炎患者HLA-B27的比較. 醫藥論壇雜志, 2010, 31(5):78-79.
24.	胡慶宏, 易誠予, 彭燕, 等. 江西地區強直性脊柱炎與HLA-B27基因關聯性. 中國組織工程研究與臨床康復, 2009, 13(46):9183-9186.
25.	陳志堅, 李山. 廣西壯族強直性脊柱炎患者HLA-B27的檢測. 廣西醫科大學學報, 2007, 24(6):928-929.
26.	陳志堅, 李山. 強直性脊柱炎患者 HLA-B27的檢測. 華中醫學雜志, 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, 陳建平, 楊曙梅, 等. 強直性脊柱炎患者HLA-B27、CRP和ESR的水平及相關性分析. 中國實驗診斷學, 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, 李志強. 強直性脊柱炎相關HLA-B27的研究進展. 中國輸血雜志, 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, 劉雪梅, 何林, 等. 對系統評價/Meta分析報告規范的系統評價. 中國循證醫學雜志, 2011, 11(8):971-977.
13. 張俊, 徐志偉, 李克. 診斷性試驗Meta分析的效應指標評價. 中國循證醫學雜志, 2013, 13(7):890-895.
14. 蔣娟, 熊小敏, 張衛云, 等. 人白細胞抗原HLA-B27在強直性脊柱炎中的臨床意義. 生物技術通訊, 2014, 25(3):410-411.
15. 彭萍, 張浩, 謝麗華. 聚合酶鏈式反應SSP法和酶聯免疫性脊柱炎患者HLA_B27的比較. 工企醫刊, 2014, 3:800-801.
16. 于莉. PCR-SSP法、FCM法及MLCT法檢測強直性脊柱炎患者HLA-B27對比分析. 風濕病與關節炎, 2014, 10(3):13-15.
17. 秦學軍. 人類白細胞抗原B27和免疫指標在強直性脊柱炎診斷中的應用. 實用臨床醫藥雜志, 2013,17(15):87-89.
18. 張小芳, 張運剛, 李守霞, 等. HLA-B27 與強直性脊柱炎的相關性研究. 中國現代醫學雜志, 2013, 23(36):56-59.
19. 魚惠霞, 魚云霞, 朱彩俠, 等. 強直性脊柱炎患者HLA-B27抗原表達與臨床的相關性分析. 寧夏醫學雜志, 2013, 35(10):901-903.
20. 吳娟. 檢測強直性脊柱炎患者人類白細胞抗原B27的臨床意義. 檢驗醫學與臨床, 2013, 10(6):663-665.
21. 惠麗紅. 強直性脊炎證型與HLA-B27的檢驗價值. 亞太傳統醫藥, 2013, 9(9):196-197.
22. 趙曉君, 薛鸞, 陳云飛, 等. 三種方法檢測強直性脊柱炎患者HLA-B27的效果比較. 山東醫藥, 2011, 51(43):48-49.
23. 李慧琰. PCR-SSP法與微量淋巴細胞毒試驗檢測強直性脊柱炎患者HLA-B27的比較. 醫藥論壇雜志, 2010, 31(5):78-79.
24. 胡慶宏, 易誠予, 彭燕, 等. 江西地區強直性脊柱炎與HLA-B27基因關聯性. 中國組織工程研究與臨床康復, 2009, 13(46):9183-9186.
25. 陳志堅, 李山. 廣西壯族強直性脊柱炎患者HLA-B27的檢測. 廣西醫科大學學報, 2007, 24(6):928-929.
26. 陳志堅, 李山. 強直性脊柱炎患者 HLA-B27的檢測. 華中醫學雜志, 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, 陳建平, 楊曙梅, 等. 強直性脊柱炎患者HLA-B27、CRP和ESR的水平及相關性分析. 中國實驗診斷學, 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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