白细胞滤过的血小板预防血小板输注无效和人类白细胞抗原同种免疫反应的Meta分析  

Prevention of Platelet Transfusion Refractoriness and HLA-alloimmunization by Leukocyte-filtered Platelet Transfusion: A Meta-analysis

作　　者：袁强[1] 陈雪[2] 成岚[1] 周昌华[2] 傅雪梅[2] 李幼平[1] 王乃红[2] 王莉[1] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041 [2]成都市血液中心,成都610041

出　　处：《中国医学科学院学报》2011年第4期412-420,共9页Acta Academiae Medicinae Sinicae

基　　金：成都市卫生局2009年青年基金科研课题(0916;0917)~~

摘　　要：目的系统评价白细胞滤过的血小板与标准血小板输注预防血小板输注无效(PTR)和人类白细胞抗原(HLA)同种免疫反应的效果。方法电子检索Medline数据库、EMBASE、The Cochrane Library和CBM收录的白细胞滤过血小板与标准血小板输注的随机或半随机对照试验(截至2009年12月31日),对预防PTR和HLA同种免疫反应的效果进行Meta分析。结果共检索到558篇文献,最终纳入7篇英文研究。Meta分析显示,白细胞滤过的血小板预防PTR的效果优于标准血小板[RR=0.59,95%CI(0.42,0.82),P=0.002],且发生HLA同种免疫反应的风险低于标准血小板输注[RR=0.49,95%CI(0.33,0.74),P=0.0006]。HLA同种免疫反应的风险差异在急性髓细胞样白血病患者中有统计学意义[RR=0.42,95%CI(0.32,0.56),P<0.00001],而在急性淋巴细胞白血病患者中由于样本量有限,尚未发现统计学意义[RR=0.50,95%CI(0.10,2.41),P=0.39]。结论现有研究证据显示输注白细胞滤过的血小板可减少PTR和HLA同种免疫反应的发生,预防效果优于标准血小板。但因纳入研究数量较少、样本量小、方法学质量不高,尚需开展大样本、高质量的研究进一步证实该结果。Objective To compare and assess the effectiveness of leukocyte-filtered platelet and standard platelet concentrates transfusion in preventing platelet transfusion refractoriness（PTR） and human leukocyte antigen（HLA）-alloimmunization.Methods Randomized controlled trials（RCTs） or quasi-RCTs comparing leukocyte-filtered platelet with standard platelet concentrates transfusion（up to December 31, 2009） were searched and identified from Medline,EMBASE,The Cochrane Library,and CBM.A meta-analysis was conducted with Cochrane Collaboration＇s RevMan 5.0.Results The search identified 558 citations in total,in which 7 articles in English were finally included in the meta-analysis.The analysis showed that compared with standard platelet concentrates transfusion,leukocyte-filtered platelet transfusion significantly decreased PTR [RR=0.59,95%CI（0.42,0.82）,P=0.002] and HLA-alloimmunization [RR=0.49,95%CI（0.33,0.74）,P=0.0006].Subgroup analysis showed that HLA-alloimmunization was significantly reduced by leukocyte-filtered platelet transfusion among the patients with acute myelocytic leukemia [RR=0.42,95%CI（0.32,0.56）,P0.00001],while no significant difference was detected in patients with acute lymphoblastic leukemia because of the limited sample size [RR=0.50,95%CI（0.10,2.41）,P=0.39].Conclusions The current evidence shows that leukocyte-filtered platelet transfusion can prevent PTR and HLA-alloimmunization more effectively than standard platelet transfusion.Well-designed large-scale RCTs are still needed to further confirm this finding.

关 键 词：白细胞滤过 血小板输注无效 人类白细胞抗原同种免疫反应 META分析 

分 类 号：R457.13[医药卫生—治疗学]