Serum Receptor Activator of Nuclear Factor-Kappa B Ligand Levels In Chinese Patients With Ankylosing Spondylarthritis: A Meta-Analysis

Abstract

Objective: We aimed to determine the association between serum receptor activator of nuclear factor-kappa B ligand (sRANKL) levels and ankylosing spondylarthritis (AS) in Chinese populations.Methods: The PubMed, Cochrane Library, Embase, Chinese Biomedical Database, Web of Science, China National Knowledge Infrastructure, VIP, and Wan Fang databases were searched for studies conducted before October 1, 2020 without language restrictions. STATA version 12.0 and Revman version 5.3 were used to analyze the data. The standard mean differences (SMDs) and corresponding 95% confidence intervals (95%CIs) were calculated. Results: Twelve clinical case–control studies, including 585 AS patients and 423 healthy controls, were included. The combined SMD for sRANKL suggested that the sRANKL level was significantly higher in the Chinese AS patients than in the healthy controls (SMD: 3.27, 95%CI: 2.11-4.43, P<0.00001). RANKL-related factor osteoprotegerin OPG (SMD: 0.86, 95%CI: 0.09-1.64, P<0.03) and RANKL/OPG (SMD=1.05, 95%CI=0.64-1.46, P<0.00001). Subgroup analysis indicated that the patients from North and South China had higher sRANKL levels than the controls; the patients sRANKL levels from South China were higher in the subgroup with Bath Ankylosing Spondylitis Functional Index (BASFI) >4. In terms of duration, ≤8years AS patients had higher sRANKL levels than the controls. Other subgroup analyses were conducted by region, language, source of control, age, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). In these subgroups, the sRANKL levels were significantly higher in the AS patients than in the controls. BASFI and BASDAI were sources of heterogeneity.Conclusions: The sRANKL levels are higher in the Chinese AS patients, especially among the patients from South China. sRANKL levels may be positively correlated with the pathogenesis of AS among the Chinese patients.