Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, 53715, USA.
Adv Rheumatol. 2021 Mar 10;61(1):17. doi: 10.1186/s42358-021-00175-7.
Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). Current findings regarding plasma/serum homocysteine (HCY) levels in AS patients are inconsistent. This study aims to systematically evaluate the association between circulating HCY levels and AS.
Online electronic databases (PubMed, Web of Science, Embase, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Wanfang data) were used to retrieve all relevant articles published up to May 7, 2020. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using the random-effect model, Stata16 software.
Nine articles containing 778 AS patients and 522 controls were included in this meta-analysis. No significant differences in HCY levels were found between AS and control groups (pooled SMD = 0.46, 95% CI = - 0.30 to 1.23, P = 0.23). However, subgroup analysis suggested that HCY levels were significantly higher (P < 0.05) in the AS group treated with methotrexate (MTX) compared with the control group. In contrast, HCY levels were significantly (P < 0.05) lower in the AS group receiving anti-TNF-α treatment compared with the control group. No significant differences were detected between HCY levels and disease activity scores (Bath AS disease activity index, BASDAI), and methylenetetrahydrofolate reductase (MTHFR) C677T genotype.
This meta-analysis indicates that HCY levels are similar between AS and controls, and do not correlate with disease activity. However, different medical treatments cause fluctuations of circulating HCY levels in AS patients. Further and larger-scale studies are needed to confirm these findings.
This study was registered at international prospective register of systematic reviews (PROSPERO), registration number: CRD42020184426 .
高同型半胱氨酸血症与自身免疫性疾病有关，如强直性脊柱炎（AS）、系统性红斑狼疮（SLE）和类风湿关节炎（RA）。目前关于 AS 患者血浆/血清同型半胱氨酸（HCY）水平的研究结果并不一致。本研究旨在系统评估循环 HCY 水平与 AS 之间的关系。
在线电子数据库（PubMed、Web of Science、Embase、ScienceDirect、中国知网（CNKI）和万方数据）检索截至 2020 年 5 月 7 日发表的所有相关文章。使用 Stata16 软件采用随机效应模型计算合并标准化均数差（SMD）及 95%置信区间（CI）。
本荟萃分析纳入了 9 篇文章，共包含 778 例 AS 患者和 522 例对照。AS 组与对照组的 HCY 水平无显著差异（合并 SMD=0.46，95%CI=-0.30 至 1.23，P=0.23）。然而，亚组分析表明，接受甲氨蝶呤（MTX）治疗的 AS 组 HCY 水平显著升高（P<0.05），而接受抗 TNF-α 治疗的 AS 组 HCY 水平显著降低（P<0.05）。HCY 水平与疾病活动评分（Bath AS 疾病活动指数，BASDAI）和亚甲基四氢叶酸还原酶（MTHFR）C677T 基因型无显著相关性。
本荟萃分析表明，AS 患者与对照组的 HCY 水平相似，且与疾病活动无相关性。然而，不同的医学治疗会导致 AS 患者循环 HCY 水平的波动。需要进一步更大规模的研究来证实这些发现。
本研究已在国际前瞻性系统评价注册库（PROSPERO）进行注册，注册号：CRD42020184426。
