| Background: Chronic Spontaneous Urticaria(CSU)is a common skin disease characterized by sudden appearance of wheals,itching and/or angioedema.Because of its obvious manifestations,recurrent and long duration,it seriously affects the quality of life of patients.However,the evaluation of activity,severity,and duration of CSU has been largely dependent on scoring the extent of skin lesions,pruritus and other related symptoms.As for the clinical significance of objective serological indicators,there are contradictions between current studies,and there is a lack of meta-analysis,both of which limited its clinical application.Objective: The aim of this systematic review and meta-analysis was to identify the levels of serological indicators such as C-reactive protein(CRP),D-dimer(D-D),vitamin D(Vit D)and anti-thyroid antibodies(ATA)in CSU patients and their clinical significance in CSU treatment.Methods: Data sources: literatures on serological indicators of CSU patients,including CRP,D-D,Vit D,ATA,basophil count,mean platelet volume(MPV)and total immunoglobulin E(tIgE),were identified from PubMed,Embase,Cochrane Library and Wanfang database published before December 2018.Literatures were screened based on inclusion criteria and exclusion criteria.The quality of the enrolled studies on the difference of CRP,D-D,Vit D,ATA levels between CSU patients and healthy controls was evaluated by the AHRQ evaluation criteria,all the analysis were performed using Review Manager 5.3 software and Stata/SE 12.0 was used for the sensitive analysis.The literatures on the significance of the above seven indicators in CSU activity evaluation,disease duration estimation,efficacy evaluation and treatment response prediction were statistically analyzed using Microsoft Office Excel 2016 software,the quality of evidence for the enrolled studies was assessed by the GRADE system.Results: A total of 25 articles on the difference between CRP,D-D,Vit D level and ATA positive rate in the CSU patient group and the healthy control group were enrolled(7 on CRP,5 on D-D,6 on Vit D,and 8 on ATA).The CRP level(WMD = 1.69,95% CI: 1.40 ~ 1.97,P < 0.00001),D-D level(WMD = 248.96,95% CI: 189.29 ~ 308.63,P < 0.00001)and ATA positive rate(OR=4.03,95% CI: 2.75 ~ 5.92,P < 0.00001)in CSU patients were higher than those in healthy controls,while Vit D level(WMD =-6.86,95% CI:-7.21 ~-6.51,P < 0.00001)was lower than healthy controls.For the study on the relationship between the serological indicators and disease activity,disease course,efficacy evaluation and prediction of CSU patients,a total of 57 articles were included(2 randomized controlled studies,8 case-control studies,and 47 cross-sectional studies).The results showed that: 1)the serological levels of D-D、CRP and MPV were positively correlated with CSU activity: the higher the level,the higher the CSU activity.There was not enough evidence to determine the correlation between Vit D,ATA,basophil count and tIgE with CSU activity,because of few studies on these indicators.2)The level of Vit D was not related to the duration of CSU,while positive ATA indicated a longer duration.3)Under the treatment of omalizumab,as the patient’s symptoms gradually improve,D-D levels gradually decrease,and Vit D levels gradually increase.The positive IgG-TPOAb indicated poor response to omalizumab.In addition,patients with high serological levels of D-D before treatment had poor response to cyclosporine.As the patient’s symptoms gradually improved under the treatment of cyclosporine,the D-D level gradually decreased.Patients with high levels of CRP and D-D before treatment had poor response to standard-dose second-generation antihistamines,and monitoring changes of CRP during treatment cloud help assess its efficacy.Conclusion: 1)The detection of serum levels of CRP,D-D and ATA were important for the exploration of the pathogenesis of CSU;2)serum levels of CRP,D-D and MPV could be used to assess the activity of CSU;3)D-D and Vit D could be used to evaluate the efficacy of omalizumab,patients with positive serum IgG-TPOAb had a poor response to omalizumab;4)D-D could be used to predict the response of patients to cyclosporine,and to evaluate the efficacy;5)CRP and D-D could be used to predict patients’ response to standard-dose second-generation antihistamine,and monitoring CRP during treatment can help evaluate efficacy. |
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