非小细胞肺癌p53、FHIT、K-RAS基因突变与吸烟相关性Meta分析

摘要

目的:从循证医学的角度对非小细胞肺癌患者p53、FHIT、K-RAS基因突变异常表达与吸烟相关性进行Meta分析.方法:检索中国学术期刊网全文数据库(CNKI)、中国科技期刊数据库(维普资讯网)、美国国立图书馆PubMed数据库,美国临床肿瘤学会(ASCO)论文集,辅以手工检索;检索时间段为1990年-2010年.检索出p53、FHIT、K-RAS基因突变与吸烟关系研究的文献197篇,最终符合纳入标准的文献26篇.对纳入文献进行方法学质量评价,采用Meta分析专用软件Review Manager 5.0进行统计分析.结果:共纳入26个研究,分别对有相同统计内容且可以合并统计的p53、FHIT、K-RAS基因突变与吸烟关系合并OR值并计算95%CI.分别为:吸烟人群p53基因突变率较高,表现为低表达,[OR=3.50,95%CI(2.45-5.00),总体效应检验 Z=6.88,P＜0.0001];吸烟人群K-RAS基因突变率明显偏高,表现为高表达,[OR=4.50,95%CI(3.00-6.75),总体效应检验 Z=7.26,P＜0.0001];吸烟人群FHIT基因突变率较高,表现为低表达,[OR=2.99,95%CI(1.01-8.88),总体效应检验 Z=1.98,P=0.005].结论:吸烟与p53、FHIT、K-RAS基因突变率呈正相关,其中p53、FHIT基因高表达为保护性因素,K-RAS基因高表达为危险因素.%Objective : To perfrome a Meta analysis on the relation of p53 , FHIT,K - RAS gene mutations and abnormal expression in non - small cell lung cancer patients with smoking. Methods : Chinese Academic Journals Online ( CNKI ),China Science and Technology Periodical Database ( VIP Information Network ), the U. S. National Library of PubMed database and the U. S. Society of Clinical Oncology ( ASCO ) proceedings were searched from 1990 to 2010. A systematic review identified 197 prospective studies concerning p53 , FHIT , K - RAS genes and smoking , from which 26 literatures were selected. The 26 included studies were methodologically assessed and analyzed by Review Manager 5. 0. Fixed - effects Meta - analyses were conducted for each factor to comhine odds ratio ( OR )and/or relative risk( RR )outcomes across studies by study design. Overall raw point estimates of each risk factor and associated 95％ confidence intervals( CI )were calculated. Results : A total of 26 studies were selected, the statistical content of the same statistics were pooled combined OR values and 95％ CI of p53 , FHIT, K - RAS gene mutation and smoking were caloulated p53 gene mutation in smokers was higher , showed low expression[ OR = 3 . 50 , 95 ％ CI( 2. 45 -5. 00 ) ,Z = 6. 88 ,P ＜ 0. 0001 ] ; K - RAS gene mutation in smokers was significantly higher , Showed high expression [ OR = 4. 50 ,95 ％ CI( 3. 00 - 6. 75 ) , Z = 7. 26 ,P ＜ 0. 0001 ] ; FHIT gene mutation in smokers was higher, showed low expression [ OR = 2. 99 .95 ％ CI( 1. 01 - 8. 88 ) ,Z = 1. 98 ,P = 0. 005]. Conclusion : The relationship between smoking and p53 , FHIT . K - RAS gene mutation rate was positively correlated , in which p53 , FHIT gene high expression is a protective factor,and K - RAS gene expression is a risk factor.