TNF-α基因多态性与肝移植后急性排斥反应的相关性分析

The association between polymorphism of tumor necrosis factor-alpha gene and acute rejection of liver allograft

目的探讨TNF-α基因多态性与肝移植后急性排斥反应的关系。方法计算机检索PubMed、Embase、CNKI,万方数据库,检索时限为自建库至2013年1月。运用STATA 10.0进行统计分析。以比值比（OR）及其95%可信区间（95%CI）作为效应尺度。结果根据纳入排除标准,最终纳入11篇文献,共包括了1132名肝移植受者,其中396名受者发生了急性排斥反应,余下的736名受者未发生急性排斥反应。所有文献均涉及了TNF-α-308G/A基因多态性与肝移植后急性排斥反应的相关性,其中有3篇文献还涉及了TNF-α-238G/A基因多态性与肝移植后急性排斥反应的相关性。Meta分析结果显示：①TNF-α-308G/A基因多态性与肝移植后急性排斥反应有明显相关性（A/A vs.G/A＋G/G：OR=2.82,95%CI=1.41-5.63）。根据人种进行分层分析后发现白种人TNF-α-308G/A基因多态性与肝移植后急性排斥反应有明显相关性（A/A vs G/A＋G/G：OR=2.95,95%CI=1.19-7.31）,而黄种人未发现明显相关性;②TNF-α-238G/A基因多态性与肝移植后急性排斥反应无相关性（A/A＋G/A vs G/G：OR=2.32,95%CI=0.63-8.49）。结论 TNF-α-308G/A基因多态性与肝移植后急性排斥反应有明显相关性。

[ Objective ] To explore the association between polymorphism of tumor necrosis factor-alpha gene and acute rejection of liver allograft. [ Methods ] PubMed, Embase, CNKI and Wanfang database were searched to identify eligible studies. Pooled Odds Ratios （OR） and its corresponding confidence interval （95% CI） were calculated. Statistical analysis was performed using STATA 10.0. [Results] A total of 11 studies were included, involving 1 132 liver transplant recipient, among whom 396 recipients developed acute rejection and 736 recipients did not. All studies assessed the association between TNF-α-308G/A polymorphism and acute rejection of liver allograft, while only 3 studies assessed the association between TNF-α-238G/A polymorphism and acute liver graft rejection. Metaanalysis of available data suggested： （1） TNF-α-308G/A polymorphism was associated with acute rejection of liver allograft （A/A vs. G/A＋G/G ：OR=2.82, 95% CI=1.41-5.63）; When stratified based on ethnicity, the association was found in Caucasians （A/A vs. G/A＋G/G：OR=2.95, 95%CI=1.19-7.31） but not Asians. （2）TNF-α-238G/A polymorphism may be not associated with acute rejection of liver allograft （A/A＋G/A vs. G/G： OR=2.32, 95% CI=0.63-8.49）.[ Conclusions ] TNF-α -308G/A polymorphismis associated with acute rejection of liver allografl.