Cook Andrew C, Cohen Nathan E, Patel Rishi, South Shannon, Ballantyne Marcia C
College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine - Bradenton, Bradenton, USA.
Pathology, Lake Erie College of Osteopathic Medicine - Bradenton, Bradenton, USA.
Cureus. 2024 Sep 11;16(9):e69162. doi: 10.7759/cureus.69162. eCollection 2024 Sep.
Onychomycosis (OM) is a nail infection from various fungal species, representing a worldwide dermatologic health concern. The toenails are most often affected. Comorbid chronic health conditions and environmental and genetic factors play a role in the development of OM. It has been observed that certain populations have an increased risk of developing OM, suggesting an inherited component to its etiology. Recent studies have observed the impact of the human leukocyte antigen-DR (HLA-DR) profile on the likelihood of developing OM; however, none have aggregated these studies for a meta-analysis to determine a statistical effect. The literature was systematically reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to determine the effect of the HLA-DR profile on OM susceptibility. Studies that contained HLA-DR allele frequency data on patients with OM were included. Studies that contained too much allele frequency data, did not contain HLA-DR allele frequency data, or were written in a non-English language were excluded. Google Scholar, PubMed, and Scientific Direct databases were searched. The risk of bias was assessed by using the National Institutes of Health (NIH) quality assessment case-control study tool. The results were generated using Review Manager version 5.4 by extracting and inputting HLA-DR allele frequency data into the program. The program created aggregated odds ratios that were visually represented in forest plots. A total of five articles were included in the analysis. One hundred fifty-six patients with OM were used in this analysis. Mexican mestizos and United States Caucasian populations were represented in this study. Overall, the NIH risk of bias tool revealed that most studies included did not justify their sample size, or the assessors were not blinded. Of all the HLA-DR alleles analyzed, only HLA-DR8 revealed a statistically significant result with an odds ratio of 1.70 with a 95% CI (1.05-2.76). This suggests that HLA-DR8 confers a 70% higher risk of susceptibility to OM. This finding can help identify these target populations and serve as the basis for personalized treatment solutions.
甲癣（OM）是由多种真菌引起的指甲感染，是全球范围内皮肤科关注的健康问题。脚趾甲最常受累。合并的慢性健康状况以及环境和遗传因素在甲癣的发生发展中起作用。据观察，某些人群患甲癣的风险增加，提示其病因中有遗传因素。最近的研究观察了人类白细胞抗原-DR（HLA-DR）谱对患甲癣可能性的影响；然而，尚无研究对这些研究进行汇总以进行荟萃分析来确定统计学效应。按照系统评价和荟萃分析的首选报告项目指南对文献进行系统综述，以确定HLA-DR谱对甲癣易感性的影响。纳入包含甲癣患者HLA-DR等位基因频率数据的研究。排除包含过多等位基因频率数据、不包含HLA-DR等位基因频率数据或用非英语撰写的研究。检索了谷歌学术、PubMed和科学直达数据库。使用美国国立卫生研究院（NIH）质量评估病例对照研究工具评估偏倚风险。通过提取HLA-DR等位基因频率数据并将其输入程序，使用Review Manager 5.4版生成结果。该程序创建了汇总比值比，并在森林图中直观呈现。分析共纳入五篇文章。本分析使用了156例甲癣患者。本研究纳入了墨西哥混血儿和美国白种人群。总体而言，NIH偏倚风险工具显示，大多数纳入的研究未说明其样本量的合理性，或者评估者未设盲。在所有分析的HLA-DR等位基因中，只有HLA-DR8显示出统计学显著结果，比值比为1.70，95%置信区间为（1.05 - 2.76）。这表明HLA-DR8使患甲癣的易感性风险增加70%。这一发现有助于识别这些目标人群，并为个性化治疗方案提供依据。
