【作者】 陈燕娜；

【导师】 江莲；

【作者基本信息】 河北医科大学 ， 儿科学， 2010， 硕士

【摘要】 目的:本研究旨在应用Meta分析(meta-analysis)的方法对国内外已发表的有关造血干细胞移植治疗儿童神经母细胞瘤的长期疗效和安全性的文献进行综合分析,为晚期高危神经母细胞瘤患儿治疗提供循证医学证据。方法:检索Cochrane图书馆、Pubmed、ScienceDirect、Embase、中国生物医学文献光盘数据库,中国期刊全文数据库和中国维普数据库维普及万方数据库,检索年限为1974年1月至2010年1月,收集已公开发表的有关造血干细胞移植治疗神经母细胞瘤的随机对照研究(RCT),按Meta分析的要求对检索到的原始文献进行质量评估,对符合条件的研究结果应用Revman 5.0软件进行Meta分析。结果:符合纳入标准的共5篇文献,涉及患儿共743人。纳入5年无病生存率比较的文献5篇,样本量743例,合并OR=2.13,95%可信区间为[1.5,3.01];纳入5年总生存率比较的文献5篇,合并OR=1.79,95%可信区间为[1.14,2.80];纳入治疗相关性死亡分析的文献4篇,样本量713例,合并OR=4.39,95%可信区间为[2.26,8.51];纳入第二肿瘤发生分析的文献3篇,样本量554例,合并OR=0.84,95%可信区间为[0.18,3.88]。敏感性分析显示研究结果具有良好的可靠性。结论:1、化疗、手术、放疗联合造血干细胞移植优于持续化疗,能改善高危神经母细胞瘤患儿长期生存。2、造血干细胞移植的治疗相关死亡率高于化疗组。3、移植第二肿瘤发生无明显关系。该方法是治疗高危神经母细胞瘤患儿的理想途径,但安全性有待进一步验证。更多还原

【Abstract】 Objective:In the current study, the author conducted a meta-analysis of the published literatures to evaluate the efficacy and safety of autologous hematopoietic stem cells transplantation treatment of high-risk neuroblastoma in children.Methods:The Cochrane library, Pubmed, Embase, ScienceDirect, CNKI,CBM,cqvip and wanfang data were searched from time when the database were established to January 2010.Reports on controlled trials on treating NB in children with AHSCT were collected .The methodology quality of included RCTs was assessed by the revised Jadad-score (including randomization , allocation concealment ,blinding method and withdraw) Meta–analysis of homogenous trials was manged by using revman 5.0.Results : Five studies were eligible for the Meta analysis, which enrolled a total of 743 children . Meta-analysis based on include RCTs showed the following results.There were 5 studies refer to 5-EFS and 5-OS.OR=2.13, 95%CI [1.50,3.01], OR=1.79, 95%CI [1.14,2.80]. Treat-related death were involved in 4 records OR= 4.39,95%CI [2.26 , 8.51]. There were 3 studies refer to the incidence of second malignant neoplasms ,OR=0.84,95% CI [0.18 , 3.88]. The sensitivity analyse shows the results were reliable.Conclusions: This meta-analysis showed that the treatment including chemotherapy,surgery, radiotherapy combining AHSCT is better than persistent chemotherapy,which could impove the long term efficacy in high-risk neuroblastoma in children . The related-death rate was higher than patient with chemotherapy . But there is no difference in incidence of second malignant neoplasms . AHSCT could be one of the ideal therapy for high-risk neuroblastoma .The safety of AHSCT needs more research.更多还原