Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
Bone Marrow Transplant. 2013 Oct;48(10):1350-7. doi: 10.1038/bmt.2013.61. Epub 2013 May 6.
Evidence is mixed regarding the effects of hematopoietic cell transplantation (HCT) on changes in cognitive functioning among adults. Meta-analysis, which is designed to help reconcile conflicting findings, has not yet been conducted on studies of adults receiving HCT. To fill this gap, the current study provides a systematic review and meta-analysis of cognitive functioning in adults receiving HCT. A search of PubMed, PsycInfo, CINAHL, and Cochrane Library yielded 732 abstracts, which were independently evaluated by pairs of raters. Seventeen studies were systematically reviewed; 11 were retained for meta-analysis. There was agreement that cognitive impairments are evident for a subset of patients before HCT. Meta-analytical findings of 404 patients revealed no significant changes in cognitive functioning pre- to post HCT (P-values >0.05). Age, time since transplant and TBI were not associated with changes in cognitive functioning. Patients who received autologous transplants were more likely to demonstrate improvements in attention (P=0.004). The systematic review identified several limitations of existing literature, including small, clinically heterogeneous samples. Large, cooperative group studies are needed to address these design limitations. Nevertheless, results from the current meta-analysis suggest that cognitive functioning does not significantly change following HCT.
造血细胞移植（HCT）对成年人认知功能变化的影响证据不一。元分析旨在帮助调和相互矛盾的研究结果，但尚未对接受 HCT 的成年人进行研究。为了填补这一空白，本研究对接受 HCT 的成年人的认知功能进行了系统评价和荟萃分析。对 PubMed、PsycInfo、CINAHL 和 Cochrane Library 的搜索产生了 732 份摘要，由两对评审员独立评估。对 17 项研究进行了系统评价；11 项研究被保留用于荟萃分析。有证据表明，在 HCT 之前，一部分患者存在认知障碍。对 404 名患者的荟萃分析结果显示，HCT 前后认知功能无显著变化（P 值>0.05）。年龄、移植后时间和 TBI 与认知功能变化无关。接受自体移植的患者在注意力方面更有可能表现出改善（P=0.004）。系统评价确定了现有文献的几个局限性，包括样本量小、临床异质性大。需要开展大型合作组研究来解决这些设计上的局限性。尽管如此，当前荟萃分析的结果表明，HCT 后认知功能没有显著变化。
