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目的系统评价国内有关Bcl-2在急性白血病不同病理状态中的表达及其与化疗效果的关系。方法计算机检索CBMdisc、中文科技期刊全文数据库、万方数据库、中国期刊网专题全文数据库、中国优秀硕士学位论文全文数据库、中国博士学位论文全文数据库,并辅以文献追溯的方法,收集国内公开发表的所有相关病例对照、队列研究。检索年限均为从建库至2010年5月23日。按纳入排除标准筛选文献并评价纳入研究的质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入10个研究,合计545例患者。Meta分析结果显示:Bcl-2阳性的急性白血病患者化疗后完全缓解率低于Bcl-2阴性患者,其差异有统计学意义[OR=0.26,95%CI(0.14,0.46),P<0.0001];急性淋巴细胞白血病与急性非淋巴细胞白血病患者Bcl-2阳性率差异无统计学意义[OR=0.87,95%CI(0.46,1.65),P=0.68];急性白血病患者化疗后完全缓解(CR)患者Bcl-2阳性率明显低于部分缓解者/完全不缓解者,其差异有统计学意义[SMD=–0.87,95%CI(–1.53,–0.20),P=0.01]。结论现有国内证据表明,Bcl-2表达与急性白血病患者缓解率呈显著负相关关系,Bcl-2基因的表达水平可用于急性白血病患者化疗效果考核和预后评价研究。但该结论需要更多高质量的研究进一步证实。
Objective To systematically evaluate the expression of Bcl-2 in different pathological states of acute leukemia in China and its relationship with the effect of chemotherapy. Methods We searched CBMdisc, Chinese Science and Technology Periodical Full-text Database, Wanfang Database, China Periodical Network Thematic Full-text Database, Chinese Excellent Master Thesis Database, Chinese Ph.D Thesis Database and assisted by literature retrospective method to collect domestic public published All relevant case-control, cohort studies. The search period are from the database to May 23, 2010. After screening the literature for inclusion criteria and evaluating the quality of the included studies, Meta-analysis was performed using RevMan 5.0 software. Results A total of 10 studies were included, totaling 545 patients. Meta analysis showed that the complete remission rate of patients with Bcl-2-positive acute leukemia after chemotherapy was lower than that of patients with Bcl-2 negative (OR = 0.26, 95% CI 0.14, 0.46; P <0.0001) ; The positive rate of Bcl-2 in patients with acute lymphoblastic leukemia and acute non-lymphocytic leukemia was no significant difference [OR = 0.87,95% CI (0.46,1.65), P = 0.68]; acute leukemia patients after chemotherapy complete remission ) Patients with Bcl-2 positive rate was significantly lower than those with partial / complete non-remission, the difference was statistically significant [SMD = -0.87,95% CI (-1.53, -0.20), P = 0.01]. Conclusions The available domestic evidence shows that the expression of Bcl-2 is negatively correlated with the remission rate of acute leukemia patients, and the expression of Bcl-2 gene can be used to evaluate the chemotherapy effect and prognosis of patients with acute leukemia. However, this conclusion needs more high-quality research to further confirm.