角膜移植术前人类白细胞抗原氨基酸残基匹配与术后排斥反应的相关性：系统评价和荟萃分析。
The correlation between human leucocyte antigen amino acid residue matching before keratoplasty and postoperative rejection: a systematic review and meta-analysis.
机构信息
Department of Ophthalmology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Department of Medical Equipment, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
出版信息
Ann Palliat Med. 2022 Mar;11(3):1112-1120. doi: 10.21037/apm-22-268.
BACKGROUND
At present, corneal transplantation has become the main surgical method for infectious keratitis. However, the rejection of corneal graft after operation leads to graft opacity, which is an important reason for the failure of transplantation. There is no unified conclusion whether the rejection can be reduced by matching human leucocyte antigen (HLA) before operation. The purpose of this meta-analysis is to explore the correlation between HLA locus matching and corneal transplantation rejection, so as to provide evidence-based medical evidence for clinical corneal transplantation in the treatment of infectious keratitis.
METHODS
Search English databases, such as PubMed, Medline, Embase and Evidence-based Medicine Library by computer; Chinese databases, such as China Biomedical Literature Database, China Knowledge Network (CNKI) database, Wanfang database, Weipu database, and Google Academic database. According to Cochrane Handbook 5.0 risk assessment table, two researchers made random sequence random allocation method, blind method, allocation scheme hiding, integrity of data results and quality score of research results. The bias risk evaluation of Rev Man 5.3 software was used to evaluate the risk bias of the references.
RESULTS
A total of 5 literatures were included, and 725 eyes underwent penetrating keratoplasty, all of which were randomized controlled trials (RCTs). The quality of the included articles was medium to high quality. A meta-analysis of four HLA-A matching articles showed odds ratio (OR) =0.28, 95% confidential interval (CI): (0.15, 0.51), significance test Z=4.08, P<0.0001, and the difference was statistically significant. Meta-analysis was performed on four HLA-B matching articles and showed OR =0.50, 95% CI: (0.27, 0.89), significance test Z=2.33, P=0.02, and the difference was statistically significant. Meta-analysis of four HLA-DR matching articles showed OR =0.69, 95% CI: (0.41, 1.17), significance test Z=1.39, P=0.17, and the difference was not statistically significant.
DISCUSSION
In patients with infectious keratitis undergoing corneal transplantation, preoperative matching of HLA-A, HLA-B, and HLA-DR sites played an important role in corneal transplantation. Preoperative HLA matching is of clinical significance.
背景
目前，角膜移植已成为治疗感染性角膜炎的主要手术方法。然而，术后角膜移植物排斥导致移植物混浊，这是移植失败的重要原因。对于术前是否可以通过匹配人类白细胞抗原（HLA）来减少排斥反应，尚无统一的结论。本荟萃分析的目的是探讨 HLA 位点匹配与角膜移植排斥之间的相关性，为临床治疗感染性角膜炎的角膜移植提供循证医学证据。
方法
计算机检索英文数据库如 PubMed、Medline、Embase 和循证医学图书馆；中文数据库如中国生物医学文献数据库、中国知网（CNKI）数据库、万方数据库、维普数据库和 Google 学术数据库。根据 Cochrane 手册 5.0 风险评估表，两名研究人员采用随机序列随机分配方法、盲法、分配方案隐藏、数据结果完整性和研究结果质量评分。RevMan 5.3 软件偏倚风险评估用于评估参考文献的偏倚风险。
结果
共纳入 5 篇文献，725 只眼行穿透性角膜移植术，均为随机对照试验（RCT）。纳入文献的质量为中高质量。对 4 篇 HLA-A 匹配文献进行荟萃分析，结果显示优势比（OR）=0.28，95%置信区间（CI）：（0.15，0.51），Z 值检验 Z=4.08，P<0.0001，差异有统计学意义。对 4 篇 HLA-B 匹配文献进行荟萃分析，结果显示 OR=0.50，95%CI：（0.27，0.89），Z 值检验 Z=2.33，P=0.02，差异有统计学意义。对 4 篇 HLA-DR 匹配文献进行荟萃分析，结果显示 OR=0.69，95%CI：（0.41，1.17），Z 值检验 Z=1.39，P=0.17，差异无统计学意义。
讨论
在感染性角膜炎患者行角膜移植术中，术前 HLA-A、HLA-B 和 HLA-DR 位点的匹配在角膜移植中发挥了重要作用。术前 HLA 匹配具有临床意义。
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