重组人生长激素治疗生长激素缺乏症儿童引发肿瘤相关性的Meta分析

目的 系统评价应用重组人生长激素(rhGH)治疗生长激素缺乏症(GHD)儿童后,与肿瘤发生相对危险度、肿瘤死亡率以及再发肿瘤发生相对危险度的相关性。方法 计算机检索Pubmed、EMbase、The CNKI、CBM、The Cochrane Library等中英文数据库,搜集有关应用rhGH治疗GHD后与肿瘤相关性的文献。根据Cochrane系统评价方法,进行文献资料收集、质量评价、数据提取,最后采用Revman 5.3软件进行Meta分析。结果 最终纳入16篇文献,Meta分析结果显示GHD患儿应用rhGH治疗后,肿瘤的发生风险无增加,两者无相关性(RR=0.76,95%CI为0.59~0.90,P<0.05)。应用rhGH治疗后,GHD组发生肿瘤的死亡率与预期死亡率相比,结果无统计意义,说明rhGH并不增加肿瘤患儿的死亡率(SMR=0.90,95%CI为0.77~1.05,P>0.05)。但是对于既往患有肿瘤的患者,应用rhGH后,可以使再发肿瘤的风险进一步增加,危险性增加1.3倍(RR=2.30,95%CI为1.61~3.27,P<0.05)。结论 GHD患儿应用rhGH治疗后,肿瘤发生相对风险及死亡率无明显增加,但是再发肿瘤的危险性增加1.3倍。

Meta-analysis on the association of the relativity of neoplasms and the effect of recombinant human growth hormone therapy in growth hormone deficiency.

Objective To evaluate the effectiveness of recombinant human growth hormone(rhGH) for growth hormone deficiency(GHD)with the relative risk of neoplasms,cancer mortality and the second neoplasms. Methods The research study about the application of recombinant human growth hormone in treating GHD and cancer-related literature searched in Pubmed,EMbase,The CNKI,CBM,the Cochrane Library and so on.According to the Cochrane Handbook,literature was screened,methodological quality assessed,date extrated and meta-analysis conducted using Revman 5.3 software. Results A total of 16 research references were including,the results of meta-analysis showed that the risk of neoplasms in GHD patients treated with rhGH was not higher (RR=0.76,95%CI was 0.59~0.90,P<0.05).Application of rhGH treatment,the overall mean neoplasms standardized mortality ratios(SMR) for treated patients was not significantly increased,and that rhGH did not increase mortality in patients with cancer(SMR=0.90,95%CI was 0.77~1.05,P>0.05).But for patients who previously suffered from cancer,after the application of rhGH,which could further increase neoplasms risk 1.3 times (RR=2.30,95%CI was 1.61~3.27,P<0.05). Conclution The relative risk and the SMR of neoplasms in GHD patients treated with rhGH is not higher,but the second neoplasms risk increases by about 1.3 times.