DNMT3A基因突变对急性髓系白血病预后影响的meta分析

目的:采用系统评价及meta分析方法评价DNMT3A基因突变与急性髓系白血病(AML)预后间的关联。方法:采用Cochrane系统评价方法体系,计算机检索PubMed、Embase数据库、Ovid、中国知网、中国生物医学文献数据库、万方和维普等数据库收集关于DNMT3A基因突变对AML预后影响的文献,并手工检索纳入文献的参考文献。筛选相关文献,对纳入文献评价方法学质量,提取临床对照试验数据,采用Stata 11.0软件进行meta分析。结果:本研究共纳入7个临床对照试验,合计1493例研究对象。Meta分析结果显示DNMT3A基因突变患者与无DNMT3A基因突变患者比较,两组完全缓解率差异无统计学意义(OR=1.034,P=0.905,95%CI:0.596～1.796),但DNMT3A基因突变患者无病生存期(HR=2.84,P=0.002,95%CI:1.063～4.613)和总生存期(HR=1.99, P=0.000,95%CI:1.463～2.510)均较无DNMT3A基因突变患者缩短。结论:DNMT3A基因突变是AML患者预后不良的一个独立危险因素。
Abstract: Objective: To evaluate the effects of DNMT3A gene mutation on prognosis of patients with acute myeloid leukemia (AML) by a meta-analysis.Methods: Methods of Cochrane systematic review was followed by 7 databases,including PubMed, Embase, Ovid, CNKI, CBM, WanFang Data and VIP, were searched for peer-reviewed articles related to DNMT3A gene mutations and prognosis of patients with AML.Then manual retrieval was applied into literature references. After the evaluation of quality and extract of clinical trialliterature data, Stata 11.0 was employed to perform meta-analysis.Results: Seven randomized controlled trials involving 1493 cases were included in the meta-analysis. The prognosis of patients with DNMT3A mutations and without DNMT3A mutations was compared. There was no statistically significant difference in complete remission(CR) rate (OR=1.034, 95%CI:0.596~1.796, P=0.905)between two groups, but the overall survival (OS)(HR=1.990, 95%CI:1.463~2.510, P=0.000)and disease free survival (DFS)(HR= 2.840, 95%CI :1.063~4.613, P=0.002,)of patients without DNMT3A mutations were longer than those with DNMT3A mutation.Conclusion: DNMT3A gene mutation is an independent risk factor of poor prognosis of patients with acute myeloid leukemia. Key words: Methyltransferases Leukemia, myeloid, acute Mutation Prognosis Meta-analysis as topic