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The CD4+/CD8+ Ratio in Pulmonary Tuberculosis: Systematic and Meta-Analysis Article
Yongmei Yin1, Jie Qin2, Yaping Dai1
1The 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.
Insights
The CD4+/CD8+ ratio decreases in the peripheral blood of pulmonary tuberculosis (PTB) patients, particularly new cases. However, bronchoalveolar lavage fluid (BALF) samples show an increased CD4+/CD8+ ratio in PTB patients.
Area of Science:
- Immunology
- Infectious Diseases
- Medical Research
Background:
- The CD4+/CD8+ ratio is a key clinical index for evaluating patient immunity.
- Previous studies on the CD4+/CD8+ ratio in pulmonary tuberculosis (PTB) patients have yielded controversial results.
- A meta-analysis of 15 case-control studies was conducted to clarify the changes in the CD4+/CD8+ ratio in PTB patients.
Purpose of the Study:
- To systematically evaluate the changes in the CD4+/CD8+ ratio in patients with pulmonary tuberculosis (PTB).
- To synthesize evidence from existing case-control studies regarding the CD4+/CD8+ ratio in PTB.
- To investigate potential differences in CD4+/CD8+ ratio changes based on sample type (peripheral blood vs. BALF) and disease status.
Main Methods:
- A meta-analysis of 15 case-control studies was performed.
- Heterogeneity was assessed using the I(2) test.
- Subgroup analysis, funnel plots for publication bias, and sensitivity analysis were conducted using RevMan 5.2.
Main Results:
- Peripheral blood studies (12) showed a significant decrease in the CD4+/CD8+ ratio in PTB cases (SMD: -0.45).
- Newly diagnosed PTB patients exhibited a more pronounced decrease in peripheral blood CD4+/CD8+ ratio (SMD: -2.17).
- Bronchoalveolar lavage fluid (BALF) studies indicated a significant increase in the CD4+/CD8+ ratio when analyzed by Flow Cytometry (FCM) (SMD: 4.75).
Conclusions:
- There is substantial evidence for a reduced CD4+/CD8+ ratio in the peripheral blood of PTB patients, especially newly diagnosed individuals.
- Conversely, the CD4+/CD8+ ratio in BALF samples from PTB patients is elevated when measured by FCM.
- These findings highlight distinct changes in immune cell ratios depending on the biological sample analyzed in PTB.
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.
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