PDF(Pubmed)
Abstract：
Recent studies have identified autoimmune haemolytic anaemia (AIHA) as a haematopoietic stem cell transplant (HSCT) complication that represents a significant cause of morbidity and mortality for these patients. In order to understand this autoimmune phenomenon, emerging research has focused on the prognostic factors associated with the development of the disorder. These studies have identified numerous possible associations with often contrasting and conflicting results. A systematic review and meta-analysis were performed in order to determine the effect of human leucocyte antigen (HLA) matching and donor relatedness on the risk of AIHA post-HSCT. PubMed, SCOPUS and ProQuest were searched from 1 January 1995 to 1 August 2021 using a range of keywords. Meta-analysis was performed using OpenMeta-Analyst software using a random effects model and arcsine risk difference (ARD). Eight eligible articles were identified, and meta-analysis showed an increased risk of AIHA in those who received HLA-mismatched transplants (ARD -0.082; 95% confidence interval [CI] -0.157, -0.007; p = 0.031) and those who received donations from unrelated donor sources (ARD -0.097; 95% CI -0.144, -0.051; p < 0.001). Patients who receive HSCT from HLA-matched and related donor sources have a reduced risk of developing AIHA. Healthcare practitioners should be mindful of the risk of AIHA, especially in those who receive HLA-mismatched and unrelated donor-sourced stem cells. While these findings provide further evidence for researchers investigating the pathogenesis of this HSCT complication, more studies are needed to fully understand the cause.
摘要：
最近的研究已将自身免疫性溶血性贫血（AIHA）确定为造血干细胞移植（HSCT）并发症，这是这些患者发病和死亡的重要原因。为了理解这种自身免疫现象，新兴的研究集中在与疾病发展相关的预后因素上.这些研究已经确定了许多可能的关联，通常具有对比和冲突的结果。进行了系统评价和荟萃分析，以确定人类白细胞抗原（HLA）匹配和供体亲密关系对HSCT后AIHA风险的影响。PubMed,从1995年1月1日至2021年8月1日，使用一系列关键字搜索了SCOPUS和ProQuest。使用OpenMeta-Analyst软件，使用随机效应模型和余弦风险差异（ARD）进行Meta分析。确定了八篇符合条件的文章，和荟萃分析显示,接受HLA不匹配移植的患者(ARD-0.082;95%置信区间[CI]-0.157,-0.007;p=0.031)和接受无关供体来源捐赠的患者(ARD-0.097;95%CI-0.144,-0.051;p<0.001)发生AIHA的风险增加.从HLA匹配和相关供体来源接受HSCT的患者发生AIHA的风险降低。医疗保健从业者应该注意AIHA的风险，尤其是那些接受HLA不匹配和无关供体来源干细胞的患者。虽然这些发现为研究HSCT并发症的发病机制提供了进一步的证据，需要更多的研究来充分了解原因。
