Association of gut decontamination and graft versus host disease in allogeneic hematopoietic stem cell transplantation: a meta-analysis
Association of gut decontamination and graft versus host disease in allogeneic hematopoietic stem cell transplantation: a meta-analysis
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异基因造血干细胞移植中肠道净化与移植物抗宿主病的关联：荟萃分析
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Pengcheng He
中科院分区：
文献类型：
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作者：
Xiaoning Wang;Caili Guo;Chunhong Sun;Mei Zhang;Pengcheng He
目的：在同种异体干细胞移植过程中，肠道去污对急性移植物抗宿主病（aGVHD）、慢性移植物抗宿主病（cGVHD）和总生存率（OS）的影响仍存在争议。本荟萃分析是为了解决这一有争议的话题，包括随机对照试验和非随机对照试验。方法：检索Pubmed、Embase、Web of Science和科克伦图书馆4个数据库中的医学文献。主要终点为aGVHD、cGVHD和OS。计算每种结局的相对风险或风险比和95%置信区间。结果：共纳入9项临床试验。其中，3项试验为RCT，涉及365例患者，其他试验为非RCT，涉及1,154例患者。肠道去污染的allo-HSCT患者II-IV期急性GVHD发生率较高（RR 1.25，[95%CI 1.03-1.52]），肠道去污染的allo-HSCT患者肠道急性GVHD发生率较高（RR 1.39，[95%CI 1.02-1.90]）。皮肤和肝脏aGVHD、cGVHD和OS的发生率在有肠道去污的allo-HSCT患者和无肠道去污的患者之间没有显著差异。结论：异基因造血干细胞移植过程中的肠道净化可能破坏肠道菌群的多样性，增加aGVHD的发生率，而对接受异基因造血干细胞移植的患者的cGVHD和OS没有影响。
Objectives: Controversy remains regarding the impact of gut decontamination on acute graft versus host.disease (aGVHD), chronic graft versus host disease (cGVHD), and overall survival (OS) during allogeneic stem cell.transplantation. The present meta-analysis was conducted to address this controversial topic, including randomized.controlled trials and non-randomized controlled trials. Methods: A systemic search of indexed medical literature in.four databases (Pubmed, Embase, Web of Science, and Cochrane library) was performed. Primary end points were.aGVHD, cGVHD, and OS. Relative risk or risk ratios and 95% confidence intervals were calculated for each outcome.for this meta-analysis. Results: Nine clinical trials were included. Of these, three trials were RCTs involving 365.patients while the others were non-RCTs involving 1,154 patients. Incidence of II-IV acute GVHD was higher in alloHSCT patients with gut decontamination (RR 1.25, [95% CI 1.03-1.52]) and incidence of intestinal acute GVHD was.higher in allo-HSCT patients with gut decontamination (RR 1.39, [95% CI 1.02-1.90]). Incidence of skin and liver.aGVHD, cGVHD, and OS was not significantly different between allo-HSCT patients with gut decontamination and.patients without gut decontamination. Conclusion: Gut decontamination during allogeneic stem cell transplantation.may destroy the diversity of microbiota and increase rates of aGVHD, while having no effects on cGVHD and OS of.patients undergoing allogeneic stem cell transplantations.