Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary.
Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary.
PLoS One. 2019 Feb 14;14(2):e0212329. doi: 10.1371/journal.pone.0212329. eCollection 2019.
BACKGROUND AND AIMS: Experimental data suggest that the HLA-DQ2 gene dose has a strong quantitative effect on clinical outcomes and severity of celiac disease (CD). We aimed to conduct a meta-analysis with systematic review to investigate the association between HLA-DQB102 gene doses and the characteristics of CD. METHODS: We searched seven medical databases for studies discussing HLA-DQB1 gene dose in CD and various disease characteristics, such as clinical presentation, histology, age at diagnosis, and comorbidities. Odds ratios (OR, for categorical variables) and weighted mean differences (for age) were calculated to compare patients with a double dose of HLA-DQB102 versus those with single and zero doses. Heterogeneity was tested with I2-statistics and explored by study subgroups (children and adults). RESULTS: Twenty-four publications were eligible for meta-analysis. Classical CD was more frequent with a double versus single dose of the HLA-DQB102 allele (OR = 1.758, 95%CI: 1.148-2.692, I2 = 0.0%). In pediatric studies, gene dose effect was more prominent (OR = 2.082, 95%CI: 1.189-3.646, I2 = 0.0% and OR = 3.139, 95%CI: 1.142-8.630, I2 = 0.0% for the comparisons of double versus single and double versus zero dose, respectively). Atrophic histology was more prevalent with a double versus zero dose (OR = 2.626, CI: 1.060-6.505, I2 = 21.3%). We observed no gene dose effect regarding diarrhea, age at diagnosis, the severity of villous atrophy, and the association with type 1 diabetes mellitus. CONCLUSION: A double dose of HLA-DQB102 gene seems to predispose patients to developing classical CD and villous atrophy. Risk stratification by HLA-DQB1*02 gene dose requires further clarification due to the limited available evidence.
背景与目的:实验数据表明,HLA-DQ2 基因剂量对乳糜泻(CD)的临床结局和严重程度具有很强的定量影响。我们旨在进行一项荟萃分析和系统评价,以研究 HLA-DQB1*02 基因剂量与 CD 的特征之间的关系。
方法:我们在七个医学数据库中搜索了讨论 HLA-DQB1 基因剂量与 CD 及各种疾病特征(如临床表现、组织学、诊断时年龄和合并症)之间关系的研究。计算比值比(OR,用于分类变量)和加权均数差值(用于年龄),以比较 HLA-DQB1*02 双等位基因与单等位基因和零等位基因的患者。用 I2 统计量检验异质性,并通过研究亚组(儿童和成人)进行探索。
结果:有 24 篇文献符合荟萃分析的纳入标准。与单剂量 HLA-DQB102 相比,双剂量 HLA-DQB102 更常出现经典 CD(OR = 1.758,95%CI:1.148-2.692,I2 = 0.0%)。在儿科研究中,基因剂量效应更为明显(OR = 2.082,95%CI:1.189-3.646,I2 = 0.0%和 OR = 3.139,95%CI:1.142-8.630,I2 = 0.0%,分别用于比较双剂量与单剂量和双剂量与零剂量)。与零剂量相比,双剂量 HLA-DQB1*02 更易出现萎缩性组织学(OR = 2.626,CI:1.060-6.505,I2 = 21.3%)。我们未观察到基因剂量对腹泻、诊断时年龄、绒毛萎缩严重程度和与 1 型糖尿病的相关性有影响。
结论:HLA-DQB102 基因的双等位基因似乎使患者易患经典 CD 和绒毛萎缩。由于现有证据有限,HLA-DQB102 基因剂量的风险分层需要进一步阐明。
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