背景:患有1型糖尿病(T1D)的患者表现出多自身免疫(PolyA)。然而,PolyA在T1D中的频率和分布仍然未知。
目的:我们进行了系统评价和荟萃分析,以确定T1D患者中潜伏性和显性PolyA的患病率。
方法:遵循PRISMA指南,在整个医学数据库中进行的全面搜索确定了对T1D中潜在和明显的PolyA的研究。两名研究人员独立筛选,提取的数据,并评估研究质量。使用随机效应模型来计算合并患病率,及其相应的95%置信区间(CI),用于潜在的PolyA和明显的PolyA。进行Meta回归分析以研究研究设计的效果,年龄,性别,和疾病持续时间对合并患病率的影响。
结果:共158篇文章,包括研究设计的不同组成进行了审查。该分析包括270,890名确诊为T1D的个体。性别分布均匀(男性占50.30%)。值得注意的是,我们的分析显示,PolyA的明显患病率为8.50%(95%CI,6.77至10.62),北美的比率最高(14.50%,95%CI,7.58至24.89)。此PolyA谱的进一步特征是并发自身免疫性甲状腺疾病的大量发生率(7.44%,95%CI,5.65~9.74)。此外,我们确定了T1D人群中潜伏性PolyA的显著患病率,量化为14.45%(95%CI,11.17至18.49),亚洲最常见(23.29%,95%CI,16.29至32.15)和大洋洲(21.53%,95%CI,16.48~27.62)。值得注意的是,这种潜在的PolyA现象主要表现为一系列自身抗体,包括类风湿因子,其次是Ro52,甲状腺过氧化物酶抗体,和甲状腺球蛋白抗体.疾病的持续时间与潜伏频率最高(β:0.0456,P值:0.0140)和明显的PolyA(β:0.0373,P值:0.0152)相关。通过研究设计,没有观察到合并患病率的差异。
结论:这项荟萃分析构成了在T1D背景下早期检测PolyA领域的实质性进展。T1D患者应定期进行评估,以确定潜在的并发自身免疫性疾病。尤其是随着年龄的增长。
BACKGROUND: Patients afflicted by type 1 diabetes (T1D) exhibit
polyautoimmunity (PolyA). However, the frequency and distribution of PolyA in T1D is still unknown.
OBJECTIVE: We conducted a systematic review and meta-analysis to define the prevalence of latent and overt PolyA in individuals with T1D.
METHODS: Following PRISMA guidelines, a comprehensive search across medical databases identified studies on latent and overt PolyA in T1D. Two researchers independently screened, extracted data, and assessed study quality. A random effects model was utilized to calculate the pooled prevalence, along with its corresponding 95 % confidence interval (CI), for latent PolyA and overt PolyA. Meta-regression analysis was conducted to study the effect of study designs, age, sex, and duration of disease on pooled prevalence.
RESULTS: A total of 158 articles, encompassing a diverse composition of study designs were scrutinized. The analysis included 270,890 individuals with a confirmed diagnosis of T1D. The gender was evenly distributed (50.30 % male). Notably, our analysis unveiled an overt PolyA prevalence rate of 8.50 % (95 % CI, 6.77 to 10.62), with North America having the highest rates (14.50 %, 95 % CI, 7.58 to 24.89). This PolyA profile was further characterized by a substantial incidence of concurrent autoimmune thyroid disease (7.44 %, 95 % CI, 5.65 to 9.74). Moreover, we identified a notable prevalence of latent PolyA in the T1D population, quantified at 14.45 % (95 % CI, 11.17 to 18.49) being most frequent in Asia (23.29 %, 95 % CI, 16.29 to 32.15) and Oceania (21.53 %, 95 % CI, 16.48 to 27.62). Remarkably, this latent PolyA phenomenon primarily featured an array of autoantibodies, including rheumatoid factor, followed by Ro52, thyroid peroxidase antibodies, and thyroglobulin antibodies. Duration of the disease was associated with a highest frequency of latent (β: 0.0456, P-value: 0.0140) and overt PolyA (β: 0.0373, P-value: 0.0152). No difference in the pooled prevalence by study design was observed.
CONCLUSIONS: This meta-analysis constitutes a substantial advancement in the realm of early detection of PolyA in the context of T1D. Individuals with T1D should regularly undergo assessments to identify potential concurrent autoimmune diseases, especially as they age.