Abstract
Objective
To examine the relationship of serum/plasma YKL-40 levels with rheumatoid arthritis (RA) and their correlation with RA activity and rheumatoid factor (RF) level.
Methods
We performed a meta-analysis comparing the serum/plasma YKL-40 levels between patients with RA and controls and examined the correlation coefficients of the circulating YKL-40 level with the RF level and RA activity based on the 28-joint disease activity score (DAS28), erythrocyte sedimentation rate (ESR), and C-re-active protein (CRP) level.
Results
Nine studies (707 patients with RA and 1,041 controls) were included in the meta-analysis. The YKL-40 levels were significantly higher in the RA group than in the control group (standardized mean difference [SMD]=1.071, 95% confidence interval [CI]=0.726∼1.417, p<0.001). Stratification by ethnicity showed significantly elevated YKL-40 levels in the RA groups from European, Asian, North American, and Arab populations. The YKL-40 level was significantly higher in the RA group than in the control group in both age- and sex-matched and only age-matched populations (SMD=0.937, 95% CI=0.554∼1.320, p<0.001; SMD=2.951, 95% CI=1.389∼4.512, p<0.001, respectively). Subgroup analysis by sample size showed significantly increased YKL-40 levels in the RA group in both small (n<100) and large (n>100) populations. Meta-analysis of correlation coefficients showed a significant positive correlation between the YKL-40 levels and DAS28, ESR, CRP level, and RF level (DAS28: correlation coefficient=0.381, 95% CI=0.044∼0.640, p=0.028; RF level: correlation coefficient=0.341, 95% CI=0.176∼0.487, p<0.001).
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Figure 1.
Meta-analysis of the relationship between the plasma/serum YKL-40 levels and rheumatoid arthritis (RA) in all study subjects. Std diff: standardized difference, CI: confidence interval.
![jrd-26-257f1.tif](/upload/SynapseXML/1010jrd/thumb/jrd-26-257f1.gif)
Figure 2.
Meta-analysis of the relationship between the plasma/serum YKL-40 levels and rheumatoid arthritis (RA) in each ethnic group. Std diff: standardized difference, CI: confidence interval.
![jrd-26-257f2.tif](/upload/SynapseXML/1010jrd/thumb/jrd-26-257f2.gif)
Figure 3.
Meta-analysis of the correlation coefficient between the YKL-40 levels and DAS28 (A) and ESR (B). DAS28: 28-joint disease activity score, ESR: erythrocyte sedimentation rate, CI: confidence interval.
![jrd-26-257f3.tif](/upload/SynapseXML/1010jrd/thumb/jrd-26-257f3.gif)
Table 1.
Characteristics of individual studies included in the meta-analysis
Table 2.
Meta-analysis of the YKL-40 levels between the patients with RA and controls
Groups | Population | Number of studies | Test of association | Test of heterogeneity | ||||
---|---|---|---|---|---|---|---|---|
SMD* | 95% CI | p-value | Model | p-value | I2 | |||
All | Overall | 10 | 1.071 | 0.726∼1.417 | <0.001 | R | <0.001 | 86.6 |
Ethnicity | European | 5 | 0.762 | 0.418∼1.127 | <0.001 | R | <0.001 | 74.8 |
Asian | 2 | 1.353 | 0.921∼1.785 | <0.001 | F | 0.173 | 55.8 | |
North American | 2 | 1.552 | 0.565∼2.539 | 0.002 | R | 0.001 | 90.9 | |
Arab | 1 | 0.954 | 0.494∼1.414 | <0.001 | NA | NA | NA | |
Matched for age and/or sex | Both | 7 | 0.937 | 0.554∼1.320 | <0.001 | R | 0.001 | 73.8 |
Age or sex | 3 | 2.951 | 1.389∼4.512 | <0.001 | R | <0.001 | 98.4 | |
Sample size | n<100 | 8 | 0.943 | 0.610∼1.276 | <0.001 | R | <0.001 | 70.2 |
n>100 | 2 | 1.463 | 0.358∼2.568 | 0.029 | R | <0.001 | 97.5 | |
Data type | Original | 7 | 0.824 | 0.572∼1.075 | <0.001 | R | 0.011 | 63.7 |
Calculated | 3 | 1.703 | 1.081∼2.325 | <0.001 | R | <0.001 | 76.5 |
Table 3.
Meta-analysis of the correlation coefficient between the YKL-40 level and RA activity (DAS28, ESR, and CRP level) and RF level