基因多态性与肾移植患者急性排异反应的系统评价再评价  

Correlation Between Gene Polymorphism and Acute Rejection in Renal Transplant Recipients: An Overview of Systematic Reviews

作　　者：田方圆[1] 吴斌[1] 占美[1] 罗敏[1] 徐珽[1] TIAN Fangyuan;WU Bin;ZHAN Mei;LUO Min;XU Ting(Department of Pharmacy,West China Hospital y Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院临床药学部

出　　处：《医药导报》2019年第8期1064-1069,共6页Herald of Medicine

基　　金：四川省医学科研课题项目(S16057)

摘　　要：目的评价基因多态性与肾移植患者急性排异反应关系的系统评价。方法计算机检索Medline、EMBase、The Cochrane Library(2017年8期)、中国生物医学文献数据库、中国知网、维普网和万方数据库。搜集基因多态性与肾移植患者应用钙调神经磷酸酶抑制剂后出现急性排异反应关系的系统评价,检索自建库至2017年8月截止。由2位研究人员独立进行文献筛选、数据提取和质量评价后,采用系统评价分析方法学质量的评价工具对纳入研究的方法学质量进行评价。结果共纳入11篇系统评价,AMSTAR评价结果显示:11篇均未报告,条目1“是否提供了前期设计方案”、条目4“发表情况是否已考虑在纳入标准中”和条目7“是否评价和报道纳入研究的科学性”。整体纳入研究质量偏低。此外,CTLA4+49A/G中的AA/AG基因型患者与GG基因型患者相比[OR=1.35,95%CI(1.05,1.71),P=0.02]、G基因型患者与A基因型患者相比[OR=1.21,95%CI(1.03,1.42),P=0.02],TNF-A-308中AA/AG基因型患者与GG基因型患者相比[OR=1.39,95%CI(1.06,1.82),P=0.02],CTLA-4CT60中AG/GG[OR=0.54,95%CI(0.34,0.84),P=0.007]、GG基因型患者[OR=0.56,95%CI(0.38,0.83),P=0.003]与AA基因型患者相比,G基因型患者与A基因型患者相比[OR=0.76,95%CI(0.61,0.91),P=0.012],发生肾移植急性排异反应的风险更高。因此,基因多态性会对肾移植患者急性排异反应产生影响。结论纳入研究的整体证据质量偏低,当前证据结果显示CTLA4+49A/G、TNF-A-308、IL-10-1082G/A、CTLA-4CT60基因多态性会对肾移植患者急性排异反应产生影响。受纳入研究数量和质量的影响,上述结论尚需大样本高质量临床研究予以证实。Objective To overview the systematic reviews/meta-analyses(SRs/MAs)of the correlation between gene polymorphisms and acute rejection in renal transplant recipients.Methods Databases including Medline,EMBase,The Cochrane Library(Issue 8,2017),CBM,CNKI,VIP and Wan Fang Data were searched to collect the SRs/MAs of the correlation between gene polymorphism and acute rejection in renal transplant recipients from inception to August 2017.Two reviewers independently screened literatures,extracted data and then AMSTAR tool was used to assess the methodological quality of included SRs/MAs.Results A total of 11 studies were included.The results of the AMSTAR evaluation showed that the items with the worst report were item 1“Is the previous design proposal provided”(11 articles not provided),item 4“Is the publication fact included in the inclusion criteria”(11 articles not satisfied),and item 7"Whether to evaluate and report on the scientific nature of the study included"(11 articles not provided).In addition,AA/AG genotypes in CTLA4+49A/G genotype patients compared with GG genotype,G genotype patients compared with genotype A patients,genotype AA/AG in TNF-A-308 patients compared with GG gene,DD+ID genotype in IL-10-1082 G/A compared with genotype II,AG/GG and GG genotypes in CTLA-4 CT60 compared with genotype AA,G genotype compared with genotype A have a higher risk of developing acute rejection of kidney transplants.Conclusion Current evidence shows that the overall quality of evidence included in the study is low,and the limited evidence shows that genetic polymorphism of CTLA4+49A/G,TNF-A-308,IL-10-1082 G/A,CTLA-4 CT60 affects acute rejection in renal transplant recipients.Due to the impact of the quantity and quality of the studies involved,the above conclusion still needs to be confirmed by a large sample of high-quality clinical studies.

关 键 词：基因多态性 肾移植 排异反应 急性 系统评价再评价 

分 类 号：R979.5[医药卫生—药品] R617[医药卫生—药学]