The Correlation Between HLA And Myasthenia Gravis: A Systematic Review

Objective Use the method of evidence-based medicine:the systematic review to assess the correlation between HLA and myasthenia gravis.Methods According to Systematic Reviewer’s handbook and search strategy, we formulated inclusion and exclusion criterion and searched the Cochrane library, Pubmed, CKNI, EMBASE, VIP and WANFANG databases for literatures about the correlation between HLA and myasthenia gravis, which have been published before December 31,2014. Two reviewers selected the literatures according to the criterion independently, and included all case control studies which were about the correlation between HLA and myasthenia gravis. We arranged the included literatures, assessed their quality and extracted related data. To assess the association between HLA and myasthenia gravis, we evaluate the heterogeneity among the various researches by using the Q test and I2 test; examine the publication bias by using the Begg’s and Egger’s test. The effect size was expressed with OR and 95%CI.Results We totally searched out 775 related literatures, and finally 41 case controlled studies were included, with 23 articles in English and 18 articles in Chinese. The total number of patients was 3343 and the controls was 139726.The results of meta-analyses showed that:some HLA genotype would add the onset risk of myasthenia gravis, such as:A*01[OR=1.65,95%CI (1.21,2.24)]、A*11[OR=1.38,95%CI(1.08,1.76)]、A*33[OR=1.62,95% CI(1.12, 2.33)]. B*08[OR=3.06,95%CI(2.31,4.05)]、B*46[OR=3.22,95%CI(2.24,4.63)]、 DR*05[OR=1.67,95%CI(1.09,2.56)]、DR*09[OR=4.06,95%CI(3.27,5.04)]、 DR*13[OR=1.46,95%CI(1.03,2.06)]、 DR*16[OR=1.94,95%CI(1.47,2.57)]、 DQA1*0101[OR=1.23,95%CI(1.03,1.48)]、DQA1*0102[OR=1.40,95%CI(1.13, 1.74)]、DQB1*0301[OR=1.79,95%CI(1.42,2.25)]、DQB1*0402[OR=1.99, 95%CI(1.18,3.36)]、DQB1*0501[OR=1.39,95%CI(1.11,1.74)]. DQBl*0502 [OR=2.22,95%CI(1.73,2.85)]、DQB1*0604[OR=1.54,95%CI(1.13,2.10)]、 DPB1*0501[OR=4.05,95%CI(2.43,6.74)]、DPB1*1901[OR=6.33,95%CI(2.29, 17.49)]. On the other side, DR*07[OR=0.72,95%CI(0.59,0.89)]、DQAl*0103 [OR=0.68,95%CI(0.52,0.88)]、DQA1*0201[OR=0.73,95%CI(0.57,0.95)]、 DQB1*0601[OR=0.50,95%CI(0.32,0.79)]、DQB1*0602[OR=0.62,95%CI(0.50, 0.77)]、DPB1*0202[OR=0.14,95%CI(0.05,0.37)] would decrease the onset risk of myasthenia gravis. The differences were statistically significant.Conclusions Available evidence suggests that HLA is significantly related with myasthenia gravis. HLA-A*01,*11,*33, HLA-B*08,*46, HLA-DR*05, *09,*13,*16, HLA-DQA1*0101,*0102, HLA-DQB 1*0301,*0402,*0501, *0502,0604, HLA-DPB1*O5O1 and HLA-DR*07, HLA-DQAl*0103,*0201, HLA-DQB 1*0601,*0602, HLA-DPB 1*0202 are susceptibility and protective genes of myasthenia gravis respectively.