造血干细胞移植前肌肉衰减症发生率及对预后影响的Meta分析  

Incidence of pretransplant sarcopenia and its effect on prognosis in patients receiving hematopoietic stem cell transplantation:a meta-analysis

作　　者：沈志莹 阮春红[1] 李成媛[1] 刘亚琪[1] Shen Zhiying;Ruan Chunhong;Li Chengyuan;Liu Yaqi(Department of Hematology,The Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院血液内科,长沙410013

出　　处：《中华临床营养杂志》2022年第3期167-174,共8页Chinese Journal of Clinical Nutrition

基　　金：湖南省卫生健康委一般课题(202214015169)。

摘　　要：目的通过Meta分析评价造血干细胞移植前肌肉衰减症的发生率及对预后的影响。方法检索Pub Med、Embase、Web of Science、Cochrane Library、EBSCO、CINAHL、中国生物医学文献数据库、中国知网、维普和万方数据库等数据库,检索时限为建库至2022年3月,收集关于造血干细胞移植前肌肉衰减症发生及对预后影响的队列研究及病例对照研究,并应用纽卡斯尔-渥太华量表对文献质量进行评价。经筛选文献,提取资料与评价文献质量后,采用RevMan 5.3软件进行Meta分析。结果纳入9篇队列研究,其中高质量6篇,中等质量3篇;样本量2255例,其中肌肉衰减症组862例。Meta分析结果显示,造血干细胞移植前肌肉衰减症的发生率为40%(95%CI:0.35~0.46);移植前肌肉衰减症可降低患者移植后总生存率(HR=1.73,95%CI:1.38~2.04,P=0.04)、增加患者移植后非复发死亡率(HR=1.84,95%CI:1.47~2.32,P<0.01);移植前肌肉衰减症与急性移植物抗宿主病的发生无显著相关性(OR=1.08,95%CI:0.84~1.39,P=0.55);移植前肌肉衰减症对患者住院时长的影响不显著(MD=3.57,95%CI:-0.13~7.26,P=0.06)。结论移植前肌肉衰减症与患者移植后总生存率降低、非复发死亡率增加有关。国内学者应提高对移植前肌肉衰减症的关注,进行大规模、多中心、前瞻性研究,对患者进行早期筛查,为实施预防和治疗策略提供指导。Objective To evaluate the incidence of pretransplant sarcopenia and its effect on prognosis in patients receiving hematopoietic stem cell transplantation(HSCT).Methods Several electronic databases(PubMed,Embase,Web of Science,Cochrane Library,EBSCO,CINAHL,CBM,CNKI,VIP,WanFang data)were searched from inception to March 2022.Cohort and case-control studies on the outcomes of HSCT patients with pre-transplant sarcopenia were collected,and the quality of the studies was evaluated using the Newcastle-Ottawa Scale.After literature screening,data extraction and quality evaluation,meta-analysis was performed using RevMan 5.3.Results 9 cohort studies were included,of which 6 were of high quality and 3 were of medium quality.The total sample size was 2,255 cases,including 862 cases in the sarcopenia group.The incidence of pretransplant sarcopenia in HSCT patients was 40%(95%CI:0.35 to 0.46).Pretransplant sarcopenia was associated with decreased overall survival rate(HR=1.73,95%CI:1.38 to 2.04,P=0.04)and increased non-relapse mortality after transplantation(HR=1.84,95%CI:1.47 to 2.32,P<0.01).There was no significant correlation between pretransplant sarcopenia and the incidence of acute graft-versus-host disease(OR=1.08,95%CI:0.84 to 1.39,P=0.55).Sarcopenia before transplantation had no significant effect on the duration of hospital stay(MD=3.57,95%CI:-0.13 to 7.26,P=0.06).Conclusions Pretransplant sarcopenia was associated with reduced overall survival and increased non-relapse mortality after transplantation.More attention to pretransplant sarcopenia is needed domestically and large-scale,multi-center,prospective studies assessing early screening for sarcopenia are necessary to provide guidance about prevention and treatment strategies.

关 键 词：移植前 肌肉衰减症 造血干细胞移植 预后 META分析 

分 类 号：R685[医药卫生—骨科学] R457.7[医药卫生—外科学]