DNA甲基化抑制剂治疗骨髓增生异常综合征的荟萃分析

A meta-analysis of DNA methylation inhibitors for treatment of myelodysplastic syndrome

目的：系统评价DNA甲基化抑制剂治疗骨髓增生异常综合征的有效性和安全性，为其临床应用提供可靠的依据。方法：检索Medline、Embase等主要外文数据库，应用RevMan5软件进行荟萃分析，选用比值比（OR）、风险比（HR）作为效应量，绘制森林图，评估治疗的有效性及不良反应。结果：共获得符合标准的研究4个。DNA甲基化抑制剂的完全反应率、部分反应率、血液指标改善率均优于传统的支持疗法，合并OR值分别为19．14195％可信区间（CI）（5．33～68．70）]、9．40195％CI（3．83～23．05）1、4．18195％CI（1．71～10．19）]，总生存风险、转化为急性髓系白血病风险差异无统计学意义（均P〉0．05）。在不良反应方面，血小板减少率、中性粒细胞减少率、贫血率DNA甲基化抑制剂治疗与传统支持治疗差异无统计学意义（均P〉0．05）；阿扎胞苷、地西他滨的个别血液不良反应方面可能高于支持治疗组。结论：DNA甲基化抑制剂治疗骨髓增生异常综合征具有一定的疗效．但该类药物的安全性仍需进一步仔细评估。

Objective To investigate the efficacy and safety of DNA methylation inhibitors （DMI） for treatment of myeloproliferative syndromes （MDS）. Methods The MEDLINE, EMBASE, EBSCO, Springer, Ovid and Cochrane library database were searched and a meta-analyses using RevMan5 software was performed. The odds ratio （OR） and hazard ratio （HR） were chosen as the effect scale and a forest plot was drawn to evaluate the effectiveness and adverse effects of DMI. Results Four studies meeting the criterion were obtained. DMI for treatment of MDS was superior to traditional therapy on complete response rate, partial response rate, improvement rate of the blood markers, OR value was 19.14195% confidence interval （CI） （5.33-68.70）], 9.40[95% CI （3.83-23.05）], 4.18195% CI （1.71-10.19）], respectively. However, overall risk of survival and transforming to acute myeloid leukemia had no statistically significant difference between the DMI treatment group and traditional therapy group. On adverse effects, platelet decrease rate, neutrophile granulocyte decrease rate and anemia rate had no statistically significant difference between the DMI treatment group and traditional therapy group. Adverse effects of 5-azacytidine and decitabine on blood might be higher than traditional therapy on individual occasions. Conclusions The limited evidences indicate that DMI on treatment of MDS has a certain efficacy. However, the safety of DMI drugs needs further systematical evaluation.