ObjectivesTo systematically review the proportion of Tregs in peripheral blood of patients with ankylosing spondylitis (AS) and its relationship with Treg's diffrent phenotypes.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect case-control studies on peripheral Tregs of AS patients from inception to November 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 61 case-control studies involving 2 466 AS patients and 1 879 controls were included. The results of meta-analysis showed that: the proportion of peripheral Tregs of patients with AS was significantly lower than that of the normal control (SMD=?0.905, 95%CI ?1.294 to ?0.517, P<0.000 1), and the proportion of Tregs in the disease-active group was significantly lower than that in disease-inactive group (SMD=?0.928, 95%CI ?1.431 to ?0.425, P<0.000 1). The proportion of CD4+CD25+FOXP3+Tregs and CD4+CD25+CD127low/?Tregs were lower in AS patients than that in control subjects (SMD=?2.547, 95%CI ?3.521 to ?1.573, P<0.000 1; SMD=?0.709, 95% CI ?1.056 to ?0.362, P<0.000 1). The proportion of Tregs defined by CD4+CD25low/?FOXP3+ was higher in AS patients (SMD=0.683, 95%CI 0.161 to 1.206, P=0.01). There was no significant difference betweew other phenotypes of Tregs groups.roups.ConclusionsThe reduction of Tregs may be one of the important reasons for the occurrence and development of AS, which may provide a new approach for the diagnosis and treatment of AS.
Objective To investigate the effects of combined abdominal weight training and mechanical insufflation-exsufflation (MI-E) on peak cough flow (PCF) and diaphragmatic function in patients with severe pneumonia undergoing invasive mechanical ventilation, and evaluate the predictive value of PCF combined with diaphragmatic ultrasound parameters for weaning success. Methods A prospective randomized controlled trial was conducted. A total of 105 patients with severe pneumonia undergoing mechanical ventilation were enrolled and randomly divided into three groups: a basic care group (Group A), an abdominal weight-loading group (Group B), and an abdominal weight-loading combined with MI-E group (Group C). Ultimately, 96 patients completed the study, with 32 patients in each group. All three groups received the corresponding interventions for 7 days. On day 1 and day 7 of the intervention, the following parameters were measured: peak cough flow (PCF), maximal inspiratory pressure (MIP), maximum transdiaphragmatic pressure (Pdimax), diaphragmatic excursion (DD), diaphragmatic thickening fraction (DTF), and diaphragmatic rapid shallow breathing index (D-RSBI). After one week of intervention, a spontaneous breathing trial (SBT) was performed to assess the weaning success rate. Results Compared with Group A and Group B, Group C showed significantly higher PCF, DD, DTF, MIP and Pdimax on day 7 (all P<0.05), and significantly lower D-RSBI (P<0.05). The weaning success rates in the three groups were 34.4% (11/32) in Group A, 56.2% (18/32) in Group B, and 78.1% (25/32) in Group C, with Group C being significantly higher than Group A and Group B (P<0.05). The patients in the weaning success group (n=54) had higher PCF, DD, DTF, and MIP, and lower D-RSBI compared with the weaning failure group (n=42) (all P<0.05). Multivariate logistic regression with weaning failure as outcome showed that higher PCF (OR=0.89, 95%CI 0.83-0.95), DD (OR=0.72, 95%CI 0.60-0.87), and DTF (OR=0.92, 95%CI 0.86-0.97) were protective factors against weaning failure (all P<0.05), while higher D-RSBI (OR=1.15, 95%CI 1.05-1.26) was a risk factor (P=0.002). Receiver operating characteristic curve analysis showed that the areas under the curve (AUC) for PCF, DD, DTF, and D-RSBI in predicting weaning success were 0.81, 0.78, 0.80, and 0.75, respectively, while the AUC of the combined PCF+DD+DTF model reached 0.91 (95%CI 0.86-0.96), with a sensitivity of 87.7% and a specificity of 87.1%. Conclusions Abdominal weight training combined with MI-E can significantly improve peak cough flow, diaphragmatic function, and weaning success rate in mechanically ventilated patients with severe pneumonia. The prediction model combining PCF, DD, and DTF demonstrates excellent predictive value for weaning success.