粒细胞集落刺激因子降低急性白血病化疗后感染的效果评价

Treatment of acute leukemia in infection control after chemotherapy with granulocyte colony-stimulating factor: A Meta-analysis

目的系统评价粒细胞集落刺激因子(G-CSF)对急性白血病患者(AL)在化疗后出现感染的疗效。方法收集1996年1月-2012年4月发表在Pubmed、中国期刊全文数据库(CNKI)和万方数据库上相关随机对照试验研究的文献,用Stata 11.0软件进行Meta分析,包括异质性检验、相应的效应值合并及偏倚的评估。结果共纳入18个随机对照试验。Meta分析结果显示,AL患者化疗后加用G-CSF降低感染的RR=0.73(95%CI:0.62～0.86,P=0.000);急性淋巴细胞性白血病(ALL)患者化疗后加用G-CSF的RR=0.82(95%CI:0.70～0.96,P=0.016);急性髓细胞白血病(AML)患者化疗后加用G-CSF的RR=0.95(95%CI:0.84～1.07,P=0.410)。国外AL患者化疗后加用G-CSF降低感染的RR=0.90(95%CI:0.81～0.99,P=0.031);中国AL患者化疗后加用G-CSF降低感染的RR=0.48(95%CI:0.38～0.60,P=0.000)。结论 AL患者诱导缓解和巩固化疗早期加用G-CSF能降低感染率,这种效果主要体现在ALL患者中而对AML的效果不明显;国内外AL患者使用G-CSF降低感染的疗效一致。

Objective To evaluate the effeeacy of granulocyte colony stimulating factor （G-CSF） in patients with acute leukemia （AL） after chemotherapy of infection. Methods The literatures of randomized-controlled-trial studies were selected from Pubmed, China Academic Journal （CNKI） and WanFang Data from January 1996 to April 2012. Stata 11.0 was applied to carry out the Meta analysis including literature heterogeneity test, value＇s merger and publication bias assessment, etc. Results A total of 18 randomized controlled trials were selected. The results of Meta-analyses showed that the combined effect was RR = 0.73 （95 % CI：0. 62 - 0.86, P = 0. 000） for AL patients with G-CFS in infection ＇after chemotherapy ; RR = 0.82 （95 % CI ：0.70 - 0. 96, P = 0. 016） for acute lymphoblastic leukemia （ALL） patients with G-CSF, RR = 0.95 （95% CI：0. 84 - 1.07, P = 0. 410） for acute myelocytic leukemia （AML） patients with G-CSF;RR =0.90（95% CI：0. 81 -0.99 ,P = 0. 031 ） for foreign AL patients with G-CSF;RR = . 48 （95% CI：0. 38 -0.60,P =0. 000） for Chinese AL patients with G-CSF. Conclusions G-CSF can reduce the infection rate of AL patients, especially for ALL patients. However,it was not demonstrated that G-CSF could reduce infection rate of AML patients. AL patients at home and abroad have the same effect treated with G-CSF.