自体干细胞移植治疗免疫球蛋白轻链型淀粉样变性Meta分析  

Autologous stem cell transplantation in immunoglobulin light chain amyloidosis:systematic review and a meta-analysis

作　　者：曲悦 王顺[1] 热西旦.扎克尔 韩媛媛[1] 桑晓红[1] 李素华[1] QU Yue;WANG Shun;Rexidan Zhakeer;HAN Yuanyuan;SANG Xiaohong;LI Suhua(Department of Nepkropathy,tke First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院肾病科,乌鲁木齐830054

出　　处：《新疆医科大学学报》2018年第6期683-688,共6页Journal of Xinjiang Medical University

基　　金：国家科技支撑计划项目(2015BAI12B05)

摘　　要：目的比较化疗药物联合自体干细胞移植与自体干细胞移植治疗免疫球蛋白轻链型淀粉样变性患者的疗效。方法计算机检索数据库,筛选化疗药物联合自体干细胞移植与自体干细胞移植治疗免疫球蛋白轻链型淀粉样变性的中文或英文的随机对照试验及单臂前瞻性研究,提取数据,采用Review Manager 5.3软件进行统计分析。结果纳入2篇随机对照试验及5篇单臂前瞻性研究,共纳入369例患者。2项随机对照试验研究中与自体干细胞移植组相比,化疗药物联合自体干细胞移植组治疗淀粉样变性患者的血液学完全缓解率、肾脏反应、移植相关死亡率及总生存期均无统计学差异(HR=1.41,95%CI:0.72~2.77,P=0.32;HR=1.30,95%CI:0.77~2.19,P=0.33;HR=0.76,95%CI:0.54~1.07,P=0.12;HR=1.11,95%CI:0.69~1.77,P=0.68)。单臂前瞻性研究中化疗药物联合自体干细胞移植可以提高血液学完全缓解率(OR=2.33,95%CI:1.06~5.11,P=0.03);肾脏反应无统计学差异(OR=1.36,95%CI:0.91~2.05,P=0.13)。结论化疗药物联合自体干细胞移植可以提高血液学完全缓解率,但与自体干细胞移植治疗相比对肾脏反应、移植相关死亡率及总生存期无显著改善。Objective To evaluate the efficacy of autologous stem cell transplantation（ASCT）versus chemotherapy combined with ASCT on patients with immunoglobulin light chain（AL）amyloidosis.Methods A comprehensive literature search（Embase,Pubmed）was undertaken.After data extraction,the Review Manager 5.3 software was used to statistical analysis.Results There were two randomized controlled trial（RCT）,five single-arm prospective studies,and 369 patients were analyzed in total.In RCT study,compared with ASCT group,the hematologic remission rate,renal response,transplant related overall survival of chemotherapy combined with ASCT Group had no statistical significance（HR：1.41,95%CI：0.72-2.77,P=0.32;HR：1.30,95%CI：0.77-2.19,P=0.33;HR：0.76,95%CI：0.54-1.07,P=0.12;HR：1.11,95%CI：0.69-1.77,P =0.68）.In the non-RCT studies,the chemotherapy combined with ASCT could improve the hematologic remission rate（OR：2.33,95%CI：1.06-5.11,P =0.03）;The renal reaction was not statistically significant（OR ：1.36,95%CI：0.91-2.05,P =0.13）.Conclusion Current clinical evidence showed that compared with ASCT,chemotherapy combined with ASCT may improve hematologic remission rate,but not for the renal response,transplant related overall survival.

关 键 词：化疗药物 自体干细胞移植 免疫球蛋白轻链型淀粉样变性 

分 类 号：R597[医药卫生—内科学]