Wang Jia, Shen Ping, Wu Xiangru, Jin Wenjie
Department of Pathology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P.R. China.
Department of Pathology, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P.R. China.
Exp Ther Med. 2020 Apr;19(4):3104-3112. doi: 10.3892/etm.2020.8536. Epub 2020 Feb 19.
Acquired aplastic anemia (AA) is a rare hematological disease characterized by bone marrow hypocellularity and varying degrees of pancytopenia. Immunosuppressive therapy (IST) is currently one of the first-line treatments for AA; however, unresponsiveness remains a major concern. Although previous studies have suggested several common risk factors for unresponsiveness, there are currently no widely accepted predictors. Therefore, a meta-analysis of clinical trials including information on factors associated with unresponsiveness of AA to IST was performed in the present study. The PubMed, Embase and Cochrane Library databases were searched for clinical studies on AA evaluating the association between risk factors and unresponsiveness to IST. After the factors were defined from the selected studies, the association between these factors and unresponsiveness to IST was analyzed using Review Manager software. A total of 10 studies comprising 1,820 cases were included in the present meta-analysis. The following factors were identified as predictors of unresponsiveness: Age (≥60 years), sex, absolute neutrophil count, severity of the disease, paroxysmal nocturnal hemoglobinuria clone, human leukocyte antigen (HLA)-DR2 and cytogenetic abnormalities (CAs). Among these factors, only age (≥60 years) [odds ratio (OR)=1.65], HLA-DR2 negativity (OR=2.72) and CAs (OR=1.93) exhibited a statistically significant association with unresponsiveness to IST (P=0.006, P=0.04 and P=0.01, respectively). In conclusion, the present meta-analysis revealed that age ≥60 years, HLA-DR2 negativity and CAs are risk factors for unresponsiveness to IST. This result may enable clinicians to select an effective therapeutic scheme for patients with AA and even provide novel clues to the pathogenesis of AA.
获得性再生障碍性贫血（AA）是一种罕见的血液系统疾病，其特征为骨髓细胞减少和不同程度的全血细胞减少。免疫抑制治疗（IST）是目前AA的一线治疗方法之一；然而，无反应性仍然是一个主要问题。尽管先前的研究已经提出了几个无反应性的常见风险因素，但目前尚无被广泛接受的预测指标。因此，本研究对包括与AA对IST无反应性相关因素信息的临床试验进行了荟萃分析。在PubMed、Embase和Cochrane图书馆数据库中检索关于AA的临床研究，以评估风险因素与IST无反应性之间的关联。从选定的研究中确定因素后，使用Review Manager软件分析这些因素与IST无反应性之间的关联。本荟萃分析共纳入10项研究，包括1820例病例。以下因素被确定为无反应性的预测指标：年龄（≥60岁）、性别、绝对中性粒细胞计数、疾病严重程度、阵发性睡眠性血红蛋白尿克隆、人类白细胞抗原（HLA）-DR2和细胞遗传学异常（CAs）。在这些因素中，只有年龄（≥60岁）[比值比（OR）=1.65]、HLA-DR2阴性（OR=2.72）和CAs（OR=1.93）与IST无反应性表现出统计学上的显著关联（P分别为0.006、0.04和0.01）。总之，本荟萃分析表明，年龄≥60岁、HLA-DR2阴性和CAs是IST无反应性的风险因素。这一结果可能使临床医生能够为AA患者选择有效的治疗方案，甚至为AA的发病机制提供新的线索。
