泼尼松诱导试验与儿童急性淋巴细胞白血病预后关系的Meta分析

Prognostic relationship of prednisone induced test and acute lymphoblastic leukemia in children： a meta - analysis

目的系统分析泼尼松诱导试验结果对评估儿童急性淋巴细胞白血病（ALL）的预后价值。方法检索1980年1月至2016年11月PubMed、Embase、The Cochrane Library、万方数据库、维普数据库、中国知网数据库，按照既定纳入排除标准检索泼尼松诱导试验对儿童ALL预后评估的相关文献。2位研究者独立进行文献筛选、提取数据和评价文献质量后采用RevMan5.3软件进行Meta分析。结果共纳入17篇文献，Meta分析显示，经完成泼尼松诱导试验的患儿，泼尼松反应良好（PGR）组的5年无事件生存率（5 y-EFS）、8年无事件生存率（8 y-EFS）均优于泼尼松反应不良（PPR）组[均差（MD）＝22.03，95%CI：18.87～25.18，P〈0.000 01；MD＝27.90，95%CI：20.94～34.85，P〈0.000 01]，PGR组持续完全缓解率较高[比值比（OR）＝4.82，95%CI：2.81～8.29，P〈0.000 01]，且复发率较低（OR＝0.26，95%CI：0.11～0.59，P＝0.001），差异均有统计学意义。PGR组与PPR组T淋巴细胞免疫分型[相对危险度（RR）＝0.30，95%CI：0.20～0.44，P〈0.000 01]、初始外周血白细胞计数（OR＝0.11，95%CI：0.08～0.16，P〈0.000 01）、第19天（D19）骨髓反应（M1、M2） （OR＝8.53，95%CI：2.85～25.52，P＝0.000 1；OR＝0.12，95%CI：0.03～0.39，P＝0.000 5）比较差异均有统计学意义。PGR组与PPR组性别（男性）（OR＝0.89，95%CI：0.62～1.28，P＝0.53）、D19骨髓反应（M3） （OR＝0.24，95%CI：0.04～1.44，P＝0.12）比较差异均无统计学意义。结论泼尼松诱导试验是评估儿童ALL预后的重要指标，基于泼尼松诱导试验选择的治疗可改善ALL患儿的预后。

ObjectiveTo systematically review the prednisone-induced test results for the prognosis assessment of acute lymphoblastic leukemia（ALL） in children.MethodsBased on the established inclusion and exclusion criteria, studies of prednisone-induced test in evaluating the prognosis of childhood ALL were electronically searched from January 1990 to November 2016 from PubMed, Embase, The Cochrane Library, WanFang, VIP and CNKI database.Two independent researchers browsed literature, extracted data and evaluated the literature quality, Meta-analysis was performed by using RevMen5.3 software.ResultsA total of 17 articles were included.Meta analysis showed that after completing prednisone induced test in children, the 5 year-event-free survival（5 y-EFS） and 8 y-EFS of good response to prednisone （PGR） was better than that of poor response（PPR） group to prednisone [mean deviation（MD）=22.03, 95%CI： 18.87-25.18, P〈0.000 01; MD=27.90, 95%CI： 20.94-34.85, P〈0.000 01]. The continuous complete remission rate and recurrence rate in 2 groups were compared, and the continuous complete remission of PGR group was high [odds ratio（OR）=4.82, 95%CI： 2.81-8.29, P〈0.000 01] and the recurrence rate was low（OR=0.26, 95%CI： 0.11-0.59, P=0.001）, and all the differences were statistically significant.There were statistical significance in T cell immune typing, the initial white blood cell count and at day 19（D19） bone marrow（M1, M2） between 2 groups[relative risk（RR）=0.30, 95%CI： 0.20-0.44, P〈0.000 01; OR=0.11, 95%CI： 0.08-0.16, P〈0.000 01; OR=8.53, 95%CI： 2.85-25.52, P=0.000 1; OR=0.12, 95%CI： 0.03-0.39, P=0.000 5]. There was no statistical significance in gender（male） and D19 bone marrow（M3） between 2 groups （OR=0.89, 95%CI： 0.62-1.28, P=0.53; OR=0.24, 95%CI： 0.04-1.44, P=0.12）.ConclusionThe prednisone induction test is an important index to evaluate the prognosis of children with ALL, and the treatment of prednisone induced test based on selection can improve the prognosis of children.