羟基脲治疗在预防镰状细胞病器官损伤中的作用：系统评价和荟萃分析。
Role of hydroxyurea therapy in the prevention of organ damage in sickle cell disease: a systematic review and meta-analysis.
机构信息
Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India.
Department of Transfusion Transmitted Disease, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India.
出版信息
Syst Rev. 2024 Feb 8;13(1):60. doi: 10.1186/s13643-024-02461-z.
BACKGROUND
Hydroxyurea is an affordable drug that reduces vaso-occlusive crises and transfusion requirements in sickle cell disease. However, its effectiveness in preventing chronic organ damage is still unclear. This systematic review and meta-analysis aimed to evaluate the role of hydroxyurea in preventing organ morbidity.
METHOD
We included original articles published in English from 1st January 1990 to 31st January 2023, reporting hydroxyurea therapy and organ damage from PubMed, Google Scholar, Scopus, and CrossRef databases. A total of 45 studies with 4681 sickle cell disease patients were evaluated for organ damage.
RESULTS
Our analysis showed that hydroxyurea intervention significantly lowered transcranial Doppler and tricuspid regurgitant velocity, with a standardized mean difference of - 1.03 (- 1.49; - 0.58); I = 96% and - 1.37 (CI - 2.31, - 0.42); I = 94%, respectively. Moreover, the pooled estimate for albuminuria showed a beneficial effect post-hydroxyurea therapy by reducing the risk of albuminuria by 58% (risk ratio of 0.42 (0.28; 0.63); I = 28%).
CONCLUSION
Our study found that a hydroxyurea dose above 20 mg/kg/day with a mean rise in HbF by 18.46% post-hydroxyurea therapy had a beneficial role in reducing transcranial doppler velocity, tricuspid regurgitant velocity, albuminuria, and splenic abnormality.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42023401187.
背景
羟基脲是一种价格低廉的药物，可减少镰状细胞病中的血管阻塞性危象和输血需求。然而，其预防慢性器官损害的效果仍不清楚。本系统评价和荟萃分析旨在评估羟基脲在预防器官发病中的作用。
方法
我们纳入了 1990 年 1 月 1 日至 2023 年 1 月 31 日期间发表的英语原始文章，检索了 PubMed、Google Scholar、Scopus 和 CrossRef 数据库中有关羟基脲治疗和器官损害的报道。共评估了 45 项研究，涉及 4681 例镰状细胞病患者的器官损害情况。
结果
我们的分析表明，羟基脲干预显著降低了经颅多普勒和三尖瓣反流速度，标准化均数差值分别为-1.03（-1.49；-0.58）；I²=96%和-1.37（CI-2.31，-0.42）；I²=94%。此外，白蛋白尿的汇总估计值表明羟基脲治疗后具有有益作用，可将白蛋白尿的风险降低 58%（风险比 0.42（0.28；0.63）；I²=28%）。
结论
我们的研究发现，羟基脲剂量超过 20mg/kg/天，且羟基脲治疗后 HbF 平均升高 18.46%，可在降低经颅多普勒速度、三尖瓣反流速度、白蛋白尿和脾脏异常方面发挥有益作用。
系统评价注册
PROSPERO CRD42023401187。
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