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The CD4+/CD8+ Ratio in Pulmonary Tuberculosis: Systematic and Meta-Analysis Article.

Yin Y, Qin J, Dai Y, Zeng F, Pei H, Wang J - Iran. J. Public Health (2015)

Bottom Line: Eight studies presented a significant decrease of CD4+/CD8+ ratio in PTB cases compared to healthy subjects (SMD: -0.45; 95% CI -0.65--0.25; I(2) = 7%).Other four studies researched on the newly diagnosed patients presented a more seriously and significantly decrease (SMD: -2.17; 95% CI -2.61--1.74; I(2) = 37%).The present meta-analysis indicated that there was a synthetic evidence for the reduced CD4+/CD8+ ratio in peripheral blood of PTB patients, especially newly diagnosed cases.

View Article: PubMed Central - PubMed

Affiliation: The Fifth People's Hospital of Wuxi, Affiliated to Jiangnan University, Wuxi, Jiangsu, China ; The Hospital for Infectious Diseases of Wuxi, Affiliated to Jiangnan University, Wuxi, Jiangsu, China.

ABSTRACT

Background: The ratio of CD4+/CD8+ has been used as a clinically index to evaluate patients' immunity. Numerous researchers have studied CD4+/CD8+ ratio in pulmonary tuberculosis (PTB) patients. However, the change of CD4+/CD8+ ratio remains controversial. We present a meta-analysis of 15 case-control studies to identify the change of CD4+/CD8+ ratio in PTB patients.

Methods: We assessed heterogeneity of effect estimates within each group using I(2) test. Subgroup analysis was performed to explore the potential source of heterogeneity. To investigate further the potential publication bias, we visually examined the funnel plots. For robustness of results, we performed sensitivity analysis by removing studies. Data entry and analyses were carried out with RevMan 5.2 (The Nordic Cochrane Centre).

Results: Twelve peripheral blood studies were categorized into two subgroups. Eight studies presented a significant decrease of CD4+/CD8+ ratio in PTB cases compared to healthy subjects (SMD: -0.45; 95% CI -0.65--0.25; I(2) = 7%). Other four studies researched on the newly diagnosed patients presented a more seriously and significantly decrease (SMD: -2.17; 95% CI -2.61--1.74; I(2) = 37%). The pooled analysis of bronchoalveolar lavage fluid (BALF) studies showed a significant increase of CD4+/CD8+ ratio using Flow Cytometry (FCM) (SMD: 4.75; 95% CI 3.44-6.05; I(2) =0%).

Conclusion: The present meta-analysis indicated that there was a synthetic evidence for the reduced CD4+/CD8+ ratio in peripheral blood of PTB patients, especially newly diagnosed cases. However, the CD4+/CD8+ ratio in BALF was increased using method of FCM.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of studies selection procedure
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Related In: Results  -  Collection


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Figure 1: Flow diagram of studies selection procedure

Mentions: Figure 1 provides the flow chart indicating the literature review process. Based on the inclusion criteria, 41 full articles were retrieved and 15 of these were included in final analysis. Some studies were excluded for the following reasons: 1) no provision of specific data on CD4+/CD8+ ratio (7–14); 2) cases of PTB was not representative, patients were divided into different groups, such as, cavitary and non-cavitary cases (15), poor general condition and good general condition cases (4), MDRTB and NRTB cases (16); 3) there was no comparison group for healthy subjects (17–21); 4) there were EPTB and HIV patients included (22–29); 5) the method of quantifying lymphocyte subpopulation was tentative (30, 31). All of these 15 studies were published in English. Table 1 presents the characteristics of included 15 studies, n = 424 PTB cases and n = 307 healthy subjects reported. These included 10 studies researched on peripheral blood, 3 studies researched on BALF and 2 studies researched on peripheral blood and BALF simultaneously. Eleven studies quantified lymphocyte by FCM method and the rest by FM method. They were all case-control studies. Three studies (36.8%) were performed in the Iran (32–34), whereas two each (10.5%) were in China (35, 36) and Turkey (37, 38), one each (5.3%) in Netherland (39), Poland (40), Brazil (41), Kuwait (42), India (43), South Africa (44), Taiwan (45), and Saudi Arabia (46).


The CD4+/CD8+ Ratio in Pulmonary Tuberculosis: Systematic and Meta-Analysis Article.

Yin Y, Qin J, Dai Y, Zeng F, Pei H, Wang J - Iran. J. Public Health (2015)

Flow diagram of studies selection procedure
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4401876&req=5

Figure 1: Flow diagram of studies selection procedure
Mentions: Figure 1 provides the flow chart indicating the literature review process. Based on the inclusion criteria, 41 full articles were retrieved and 15 of these were included in final analysis. Some studies were excluded for the following reasons: 1) no provision of specific data on CD4+/CD8+ ratio (7–14); 2) cases of PTB was not representative, patients were divided into different groups, such as, cavitary and non-cavitary cases (15), poor general condition and good general condition cases (4), MDRTB and NRTB cases (16); 3) there was no comparison group for healthy subjects (17–21); 4) there were EPTB and HIV patients included (22–29); 5) the method of quantifying lymphocyte subpopulation was tentative (30, 31). All of these 15 studies were published in English. Table 1 presents the characteristics of included 15 studies, n = 424 PTB cases and n = 307 healthy subjects reported. These included 10 studies researched on peripheral blood, 3 studies researched on BALF and 2 studies researched on peripheral blood and BALF simultaneously. Eleven studies quantified lymphocyte by FCM method and the rest by FM method. They were all case-control studies. Three studies (36.8%) were performed in the Iran (32–34), whereas two each (10.5%) were in China (35, 36) and Turkey (37, 38), one each (5.3%) in Netherland (39), Poland (40), Brazil (41), Kuwait (42), India (43), South Africa (44), Taiwan (45), and Saudi Arabia (46).

Bottom Line: Eight studies presented a significant decrease of CD4+/CD8+ ratio in PTB cases compared to healthy subjects (SMD: -0.45; 95% CI -0.65--0.25; I(2) = 7%).Other four studies researched on the newly diagnosed patients presented a more seriously and significantly decrease (SMD: -2.17; 95% CI -2.61--1.74; I(2) = 37%).The present meta-analysis indicated that there was a synthetic evidence for the reduced CD4+/CD8+ ratio in peripheral blood of PTB patients, especially newly diagnosed cases.

View Article: PubMed Central - PubMed

Affiliation: The Fifth People's Hospital of Wuxi, Affiliated to Jiangnan University, Wuxi, Jiangsu, China ; The Hospital for Infectious Diseases of Wuxi, Affiliated to Jiangnan University, Wuxi, Jiangsu, China.

ABSTRACT

Background: The ratio of CD4+/CD8+ has been used as a clinically index to evaluate patients' immunity. Numerous researchers have studied CD4+/CD8+ ratio in pulmonary tuberculosis (PTB) patients. However, the change of CD4+/CD8+ ratio remains controversial. We present a meta-analysis of 15 case-control studies to identify the change of CD4+/CD8+ ratio in PTB patients.

Methods: We assessed heterogeneity of effect estimates within each group using I(2) test. Subgroup analysis was performed to explore the potential source of heterogeneity. To investigate further the potential publication bias, we visually examined the funnel plots. For robustness of results, we performed sensitivity analysis by removing studies. Data entry and analyses were carried out with RevMan 5.2 (The Nordic Cochrane Centre).

Results: Twelve peripheral blood studies were categorized into two subgroups. Eight studies presented a significant decrease of CD4+/CD8+ ratio in PTB cases compared to healthy subjects (SMD: -0.45; 95% CI -0.65--0.25; I(2) = 7%). Other four studies researched on the newly diagnosed patients presented a more seriously and significantly decrease (SMD: -2.17; 95% CI -2.61--1.74; I(2) = 37%). The pooled analysis of bronchoalveolar lavage fluid (BALF) studies showed a significant increase of CD4+/CD8+ ratio using Flow Cytometry (FCM) (SMD: 4.75; 95% CI 3.44-6.05; I(2) =0%).

Conclusion: The present meta-analysis indicated that there was a synthetic evidence for the reduced CD4+/CD8+ ratio in peripheral blood of PTB patients, especially newly diagnosed cases. However, the CD4+/CD8+ ratio in BALF was increased using method of FCM.

No MeSH data available.


Related in: MedlinePlus