Elevated prevalence of 21-hydroxylase antibody in individuals with type 1 diabetes mellitus: A meta-analysis

Objective Type 1 diabetes mellitus (T1DM) is a chronic disorder resulting from the autoimmune destruction of pancreatic β-cells, frequently accompanied by derangements in immune regulation. The 21-hydroxylase antibody, a specific autoantibody targeting adrenal tissue, has been widely recognized as a pivotal immunological marker for Addison's disease. Considering that the autoimmune mechanism might serve as a shared pathological foundation for both 21-hydroxylase antibody positivity and T1DM, co-occurrence of these two conditions may be observed in certain patients. This meta-analysis aims to provide more robust and statistically valid evidence by integrating the raw data from relevant studies, thereby clarifying whether a statistical association exists between 21-hydroxylase antibody positivity and T1DM.Methods A systematic search was conducted across the PubMed, Web of Science, CNKI, and CBM databases. Based on the data extracted from the retrieved studies, the odds ratio (OR) and its 95% confidence interval (CI) were calculated to assess the statistical association between the two variables.Results A total of 10 independent studies were included in this investigation, encompassing 2 852 patients with T1DM and 1 596 non-diabetic control subjects. The results of the meta-analysis indicated that the prevalence of positive 21-hydroxylase antibody among T1DM patients was significantly higher than that in the control group [OR=3.35, 95%CI(1.80, 6.24)]. Sub-group analyses revealed that, within both the Asian and American populations, the proportion of T1DM patients with positive 21-hydroxylase antibody was notably higher compared to the control groups [OR=2.99, 95%CI(1.17, 7.66); OR=8.79, 95%CI(2.04, 37.98)]. Conversely, no statistically significant association was detected in the European population [OR=1.17, 95%CI(0.36, 3.79)]. The results of sensitivity analyses and publication bias assessments affirmed the sound stability and reliability of the conclusions drawn from this meta-analysis.Conclusion The results of this meta-analysis demonstrate that the prevalence of positive 21-hydroxylase antibody is significantly elevated in patients with T1DM compared to non-diabetic controls, suggesting a potential specific immunological connection between the two entities.