免疫功能失调与慢性心力衰竭关系的Meta分析

Association between Immune Dysfunction and Chronic Heart Failure:A Meta-analysis

目的系统评价免疫功能失调与慢性心力衰竭(CHF)的关系。方法计算机检索PubMed、EMBase、Cochrane图书馆、万方数字化期刊数据库及中国知网数据库(CNKI)关于T淋巴细胞比例变化、抗β1肾上腺素受体自身抗体与CHF关系的相关研究,由2名研究者独立筛选和评价。计量资料效应尺度选择加权均数差(WMD)及95%可信区间(CI),计数资料选择比值比(OR)及95%CI。利用RevMan 5.1软件进行统计学分析。结果最终纳入22篇文献,其中9篇文献报道了外周血CD4+、CD8+细胞比例及CD4/CD8比值的变化,10篇文献报道了外周血调节性T细胞(Treg)、CD4+辅助性T细胞17(Th17)比例及Th17/Treg比值的变化,6篇文献报道了血清抗β1肾上腺素受体自身抗体的变化,均采用随机效应模型进行Meta分析。发现CHF患者外周血CD8+细胞比例〔WMD=5.67,95%CI(0.81,10.53)〕、Th17比例〔WMD=2.53,95%CI(1.98,3.08)〕、Th17/Treg比值〔WMD=1.06,95%CI(0.75,1.37)〕及血清抗β1肾上腺素受体自身抗体阳性率〔OR=10.70,95%CI(5.39,21.27)〕较对照组升高(P<0.05),Treg细胞比例较对照组降低〔WMD=-3.14,95%CI(-3.88,-2.40),P<0.05〕,而CD4+细胞比例〔WMD=-5.86,95%CI(-15.54,3.82)〕及CD4/CD8比值〔WMD=-0.31,95%CI(-1.02,0.41)〕与对照组无差异(P>0.05)。结论 CHF患者存在淋巴细胞亚群比例失衡,血清抗β1肾上腺素受体自身抗体生成增加。免疫功能失调与CHF的疾病过程密切相关。

Objective To assess the association between immune dysfunction and chronic heart failure（ CHF） systematically.Methods Articles reporting the association between T cells,anti β1- adrenergic receptor autoantibody and CHF were searched from PubMed,EMBase,Cochrane Library,Wanfang Digital Journal Database and CNKI.Literature review and data extraction were completed by two investigators independently.Weighted mean differences（ WMD） and 95% confidence interval（ CI） were calculated for quantitative data.Odd ratio（ OR） and 95% CI were also calculated for qualitative data.All statistical tests were performed with RevMan 5.1 software.Results A total of 22 articles were included.The changes of CD4^＋,CD8^＋cells and CD4/ CD8 ratios were reported in 9 articles.The changes of Treg,Th17 cells and Th17 / Treg ratios were reported in 10 articles.Six studies reported the levels of serum β1- adrenergic receptor autoantibody.A random- effects model was chosen in the meta- analysis.The results indicated that the CD8^＋cell proportion 〔WMD = 5.67,95% CI（ 0.81,10.53） 〕,Th17 cell proportion 〔WMD = 2.53,95% CI（ 1.98,3.08） 〕,Th17 / Treg ratio 〔WMD = 1.06,95% CI（ 0.75,1.37） 〕 and positive rates of β1- adrenergic receptor autoantibody〔OR = 10.70,95% CI（ 5.39,21.27） 〕were significantly higher in CHF patients compared with normal control subjects（ P〈 0.05）.Treg cell proportion 〔WMD =- 3.14,95% CI（- 3.88,- 2.40）,P〈 0.05〕 was lower than the control group.No statistically significant difference was found in the comparison of CD4＋cell proportion〔WMD =-5.86,95% CI（- 15.54,3.82） 〕and CD4/ CD8 ratio 〔WMD =- 0.31,95% CI（- 1.02,0.41） 〕（ P〉 0.05）.Conclusion The disproportion of lymphocyte subpopulations and increase of β1- adrenergic receptor autoantibody exist in CHF patients.The immune dysfunction is closely related to the process of CHF.