Department of Rheumatology, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Ave, Tianhe District, Guangzhou, 510630, China.
Clin Exp Med. 2019 Feb;19(1):23-36. doi: 10.1007/s10238-018-0535-0. Epub 2018 Oct 25.
Previous systematic reviews have found a higher sero-prevalence of EBV antibodies in SLE patients compared with controls. Because many studies have been published, there is a need to apply more precise systematic review methods. We examined the association between EBV and SLE patients by conducting a systematic review and meta-analysis of case-control studies that examined the prevalence of EBV antibodies and the DNA-positive rate. We searched the MEDLINE and EMBASE databases from 1966 to 2018 with no language restrictions. The Mantel-Haenszel odds ratios (OR) for EBV antibody sero-positivity were calculated, and meta-analyses were conducted. Quality assessment was performed using a modified version of the Newcastle-Ottawa scale, and 33 studies were included. Most studies found a higher sero-prevalence of VCA IgG and EA IgG in SLE patients compared with controls. Meta-analysis demonstrated a significantly higher OR for sero-positivity to VCA IgG and EA IgG for SLE cases (2.06 [95% confidence interval (CI) 1.30-3.26, p = 0.002] and 7.70, [95% CI 4.64-12.76, p < 0.001], respectively). The overall OR for the DNA-positive rate for SLE patients compared with controls was 3.86 (95% CI 1.52-9.83, p = 0.005). Other antibodies, i.e., VCA IgA/IgM, EBNA IgA, and EA IgA/IgM, also demonstrated a significant difference between SLE patients and controls. These findings support previous systematic reviews; however, publication bias cannot be excluded. The methodological conduct of studies could be improved, particularly when selecting controls and analyses of laboratory conduct.
先前的系统评价发现，与对照组相比，SLE 患者的 EBV 抗体血清阳性率更高。由于已有许多研究发表，因此需要应用更精确的系统评价方法。我们通过对检查 EBV 抗体和 EBV-DNA 阳性率的病例对照研究进行系统评价和荟萃分析，来评估 EBV 与 SLE 之间的相关性。我们检索了 MEDLINE 和 EMBASE 数据库，检索时间从 1966 年至 2018 年，未设语言限制。计算 EBV 抗体血清阳性的 Mantel-Haenszel 比值比（OR），并进行荟萃分析。采用纽卡斯尔-渥太华量表的改良版进行质量评估，共纳入 33 项研究。大多数研究发现，与对照组相比，SLE 患者的 VCA IgG 和 EA IgG 血清阳性率更高。荟萃分析显示，SLE 患者 VCA IgG 和 EA IgG 血清阳性的 OR 显著更高（2.06 [95%置信区间（CI）1.30-3.26，p=0.002] 和 7.70 [95% CI 4.64-12.76，p<0.001]）。与对照组相比，SLE 患者 EBV-DNA 阳性率的总 OR 为 3.86（95% CI 1.52-9.83，p=0.005）。其他抗体，即 VCA IgA/IgM、EBNA IgA 和 EA IgA/IgM，SLE 患者与对照组之间也存在显著差异。这些结果支持先前的系统评价；然而，不能排除发表偏倚。研究的方法学实施可以得到改善，特别是在选择对照组和实验室检测分析方面。
