Baodong Qin

Epidemiology of primary Sjögren's syndrome: a systematic review and meta-analysis

Objective Epidemiological studies of primary Sjögrens syndrome (pSS) are crucial for describing the burden to society and the public medical system and for shedding light on aetiology. Previous reports of the epidemiology of pSS show variable outcomes. We conducted a systematic review of the epidemiology of pSS to assess the prevalence rates (PRs) and incidence rates (IRs), and to investigate possible geographic variations in pSS. Methods A systematic literature search of PubMed and Embase (updated to 22 October 2013) was performed to identify all published reports on the epidemiology of pSS. The incidence and prevalence rates of pSS were summarised with IRs or PRs and 95% CIs. Results The literature search yielded 1880 related citations. Only 21 fulfilled the inclusion criteria. According to a random-effects model, the pooled IR for pSS was 6.92 (95% CI 4.98 to 8.86) per 100 000 person-years. The overall PR was 60.82 (95% CI 43.69 to 77.94) cases per 100 000 inhabitants with a slightly lower estimate of Baodong Qin is BDQ, Jiaqi Wang is JQW, Zaixing Yang is ZXY, Renqian Zhong is RQZ. 43.03 (25.74 to 60.31) cases per 100 000 inhabitants when only considering population-based studies. The female/male ratio in incidence data was 9.15 (95% CI 3.35 to 13.18). The female/male ratio in prevalence data was 10.72 (95% CI 7.35 to 15.62). The overall age of pSS patients was 56.16 years (95% CI 52.54 to 59.78). Conclusions Incidence and prevalence rates of pSS vary widely around the world. The results help us better understand the global epidemiology of pSS. Large population-based studies combining meticulous case-finding and case-ascertainment strategies are needed.

Primary Sjögren's syndrome and malignancy risk: a systematic review and meta-analysis

Objective To investigate the association between primary Sjögrens syndrome (pSS) and the risks of malignancy including overall malignancy and site-specific malignancies through a systematic review and meta-analysis. Methods We searched Pubmed before January 2013, with a restriction to English language publications. Studies were included if they met the following criteria: (1) a cohort or observational study; (2) pSS as one of the exposure interests; (3) cancer as an outcome of interest; (4) relative risk (RR) or standardised incidence rate (SIR) with 95% CIs. We used a random or fixed effects model to calculate the pooled RR according to the heterogeneity test. Results Fourteen studies involving more than 14 523 patients with pSS were included. Compared with the general population, patients with pSS had significantly increased risks of overall cancer (pooled RR 1.53; 95% CI 1.17 to 1.88), non-Hodgkin lymphoma (NHL) (pooled RR 13.76; 95% CI 8.53 to 18.99) and thyroid cancer (pooled RR 2.58; 95% CI 1.14 to 4.03). A significant association was found in various subgroup meta-analyses for NHL but, for overall malignancy, a significant association was only found in some groups. Additionally, the number of studies exploring the association of pSS with the risk of solid malignancies was so small that we could not carry out subgroup meta-analyses. Conclusions This meta-analysis indicates that pSS is significantly associated with increased risks of overall malignancy, NHL and thyroid cancer. However, it is not yet known whether the apparent increased risk of overall malignancy in patients with pSS is due to the relatively high prevalence of NHL in that group.

Body mass index and the risk of rheumatoid arthritis: a systematic review and dose-response meta-analysis.

IntroductionThe evidence from published studies on the association between obesity and rheumatoid arthritis has been contradictory. To clarify the association between obesity and rheumatoid arthritis, we conducted a systematic review and dose-response meta-analysis to assess the relationship between body mass index and rheumatoid arthritis risk.MethodsA systematic literature search of PubMed and Embase (up to 12 July 2014) was performed to identify all eligible published reports. The pooled relative risk results with corresponding 95% confidence intervals of rheumatoid arthritis development were estimated using a random-effects model.ResultsEleven eligible related citations fulfilled the inclusion criteria and were included in the study. Compared with individuals with a body mass index under 30, obese individuals showed an association with a significantly increased risk of rheumatoid arthritis (relative risk = 1.25, 95% confidence interval: 1.07 to 1.45, Pheterogeneity <0.01, I2 = 63%). Compared to normal weight subjects, the pooled relative risks for rheumatoid arthritis were 1.31 (1.12 to 1.53) and 1.15 (1.03 to 1.29) for the categories of obese and overweight, respectively. In the dose-response analysis, there was evidence of a nonlinear association (Pnonlinear = 0.005) and the estimated summary relative risk for a 5-unit increment was 1.03 (95% confidence interval: 1.01 to 1.05, Pheterogeneity = 0.001, I2 = 70.0%).ConclusionsAn increase in body mass index can contribute to a higher risk for rheumatoid arthritis development. However, the finding also highlights the need for research on the association between body mass index and rheumatoid arthritis risk with adjustment for more confounding factors.

Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients

Abstract Objective: Although there have been extensive investigations on neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) in many diseases, their roles in systemic lupus erythematosus (SLE) remain unclear. The purpose of the present study was to evaluate NLR, PLR, and MPV levels in adult SLE patients and explore their clinical significance. Methods: A retrospective study involving 154 adult SLE patients and 151 healthy controls was performed. All clinical characteristics of the SLE patients were extracted from their medical records. NLR, PLR, and MPV levels between SLE patients and healthy controls were compared, and correlations between these indexes and clinical characteristics were analyzed. Results: Increased NLR, PLR, and MPV were observed in SLE patients. NLR was positively correlated with C-reaction protein (r = 0.509, p < 0.01), erythrocyte sedimentation rate (r = 0.610, p < 0.01), and SLE Disease Activity Index (SLEDAI) scores (r = 0.471, p < 0.01). PLR was positively correlated with SLEDAI scores (r = 0.44, p < 0.01). SLE patients with nephritis had higher NLR and PLR levels than those without nephritis (p < 0.01, p = 0.03). In addition, an NLR level of 2.065 was determined as predictive cut-off value of SLE (sensitivity 74.7%, specificity 77.5%, AUC = 0.828). Multiple regression analysis suggested that NLR was independently associated with SLE disease activity. Conclusions: NLR and PLR could reflect inflammatory response and disease activity in SLE patients.

Polymyositis/dermatomyositis and malignancy risk: a metaanalysis study.

Objective. To investigate the association between polymyositis (PM)/dermatomyositis (DM) and risks of malignancy. Methods. We searched Pubmed for articles dated before August 16, 2013. Studies were included if they met the following criteria: (1) a cohort or observational study; (2) PM or DM as one of the exposures of interest; (3) cancer as an outcome of interest; and (4) the rate ratio (RR) or standardized incidence ratio (SIR) were available with their 95% CI. We used random-effects or fixed-effects models to calculate the pooled RR according to the heterogeneity test. Results. Twenty publications were included. Compared with the general population, the pooled RR for patients with PM, DM, and PM/DM were 1.62 (95% CI 1.19–2.04), 5.50 (4.31–6.70), and 4.07 (3.02–5.12), respectively. The increased risks were more significant in patients within the first year of myositis diagnosis, male patients, and population-based studies (for DM). A significant association was also found between PM or DM and most site-specific malignancies. However, both PM and DM were not associated with stomach and prostate cancers. Significant heterogeneity was found between studies on association between PM/DM and overall malignancy, but not between PM/DM and the majority of site-specific malignancies, suggesting that that inherent malignancy difference may be a major source of heterogeneity. Conclusion. The present metaanalysis indicates that PM and DM are significantly associated with increased risks of overall malignancy and most site-specific malignancies. The number of studies on association between PM or DM and some malignancies is too small to draw a firm conclusion. Accordingly, more research is needed for these malignancies.

Analysis of altered microRNA expression profiles in peripheral blood mononuclear cells from patients with primary biliary cirrhosis

MicroRNA, as an important regulator of gene expression, has been found to be associated with several diseases. MicroRNA expression profiles have been identified in several autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis. However, the expression profile in peripheral blood mononuclear cells (PBMCs) from primary biliary cirrhosis (PBC) patients and the role of microRNA in PBC remained unclear. The present study aimed to explore abnormal microRNA regulation in PBC.

Red blood cell distribution width and neutrophil/lymphocyte ratio are positively correlated with disease activity in primary Sjögren's syndrome

OBJECTIVE The red blood cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) are increased in various inflammation related diseases, but their clinical significance in primary Sjögrens syndrome (pSS) has not been reported. The aim of the present study was to investigate the clinical significance of RDW and NLR in pSS patients. METHODS The medical records of pSS patients who were admitted to Changhai Hospital of the Second Military Medical University between April 2012 and December 2013 were retrospectively reviewed. Correlations between RDW, NLR and the patient clinical characteristics were analyzed using the Spearman approach and the multiple linear regression model. RESULTS Fifty-two pSS patients and 58 healthy controls were enrolled. RDW and NLR were increased in pSS patients and positively correlated with the Sjögrens syndrome disease activity index (SSDAI). CONCLUSION RDW and NLR may prove to be useful indices to estimate pSS disease activity.

The Association of 5-HT2A, 5-HTT, and LEPR Polymorphisms with Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis

Objective A consensus has not been reached regarding the association of several different gene polymorphisms and susceptibility to obstructive sleep apnea syndrome (OSAS). We performed a meta-analysis to better evaluate the associations between 5-HT2A, 5-HTT, and LEPR polymorphisms, and OSAS. Method 5-HT2A, 5-HTT, and LEPR polymorphisms and OSAS were identified in PubMed and EMBASE. The pooled odd rates (ORs) with 95%CIs were estimated using a fixed-effect or random-effect models. The associations between these polymorphisms and OSAS risk were assessed using dominant, recessive and additive models. Results Twelve publications were included in this study. The -1438 “A” allele of 5-HT2A was identified as a candidate genetic risk factor for OSAS (OR: 2.33, 95%CI 1.49–3.66). Individuals carrying the -1438 “G” allele had a nearly 70% reduced risk of OSAS when compared with AA homozygotes (OR: 0.30, 95%CI 0.23–0.40). There was no significant association between 5-HT2A 102C/T and OSAS risk, using any model. The “S” allele of 5-HTTLPR conferred protection against OSAS (OR: 0.80, 95%CI 0.67–0.95), while the “10” allele of 5-HTTVNTR contributed to the risk of OSAS (OR: 2.08, 95%CI: 1.58–2.73). The “GG” genotype of LEPR was associated with a reduced risk of OSAS (OR: 0.39, 95%CI 0.17–0.88). Conclusion The meta-analysis demonstrated that 5-HTR-1438 “A” and 5-HTTVNTR “10” alleles were significantly associated with OSAS. The “S” allele of 5-HTTLPR and the “GG” genotype of LEPR conferred protection against OSAS. Further studies, such as Genome-Wide Association study (GWAS), should be conducted in a large cohort of OSAS patients to confirm our findings.

The Association between TNF-α, IL-10 Gene Polymorphisms and Primary Sjögren’s Syndrome: A Meta-Analysis and Systemic Review

Objective Previous studies have evaluated the associations of TNF-α, IL-10 gene polymorphisms and susceptibility to pSS, but the results remained controversial. To assess the associations between TNF-α-308, IL-10-1082, -819, -592 polymorphisms and pSS risk, a meta-analysis was conducted. Method The available articles were searched in PubMed, EMBASE and MEDLINE. ORs with 95% CIs were calculated to determine the strength of associations by fixed-effects or random-effects models. The data about IL-10-1082, -819, -592 polymorphisms were analyzed in the additive, dominant and recessive modes. The associations between haplotypes of IL-10 gene and susceptibility to pSS were also assessed. Results A total of 9 relevant studies were identified in the meta-analyses. TNF-α-308 A allele was significantly associated with pSS (OR = 1.8, 95% CI: 1.53–2.13). The IL-10 -1082 G allele and the genotype “GCC/ATA” were identified as a candidate genetic risk factor for pSS. Under the dominant model for −819 and −582, the overall ORs suggested that individuals with genotype (CC+TC) or (CC+AC) may have a 59% increased risk of pSS in Caucasians population (OR = 1.59, 95% CI:1.09–1.23). Besides, the genotype “ATA/ATA” may be a protective factor against the development of pSS in Caucasians (OR = 0.40, 95% CI:0.19–0.84). Conclusion The meta-analysis demonstrated TNF-α-308 A, IL-10-1082 G allele were significantly associated with pSS susceptibility, supporting these alleles were predisposing factors for pSS. In Caucasian population, the genotype “ATA/ATA” may be a protective factors.

TLR9 polymorphisms and systemic lupus erythematosus risk in Asians: A meta-analysis study

The results from previous studies on association of TLR9 polymorphisms with the risk of systemic lupus erythematosus (SLE) remained contradictory. Therefore, a meta-analysis was performed to assess the association between TLR9 polymorphisms and SLE susceptibility. A literature-based search was conducted to identify all relevant studies. Pooled data were estimated by fixed- and random-effects models when appropriate. We examined seven publications, showing that there were only three polymorphisms (-1486C/T, +1174A/G and +1635C/T) existing in Asian populations. The meta-analysis indicated that none of these three polymorphisms showed any significant association with SLE risk in Asian populations. In conclusion, the present study indicates that TLR9 polymorphisms are not candidates for susceptibility to SLE, at least, in eastern Asian population. Furthermore, a large number of studies should be performed to explore the association of TLR9 polymorphisms with the risk of SLE in other populations, such as Europeans, Americans and Africans.