[摘 要] 目的：系统评价CD19 CAR-T细胞免疫疗法对比标准治疗在复发/难治性弥漫性大B细胞淋巴瘤（R/R DLBCL）患者中疗效与安全性，通过探索性分析探索不同CAR-T细胞产品对疗效的潜在影响，为临床治疗决策提供循证参考。方法：计算机检索中国知网、万方数据库、维普期刊数据库、中国生物医学文献数据库、PubMed、Embase和Cochrane Library数据库，搜集CD19 CAR-T细胞疗法对比标准治疗用于R/R DLBCL的随机对照试验（RCT），检索时限均为建库至2025年10月25日。由2位研究者独立进行文献筛选、数据提取和质量评价，采用R4.2.2软件进行Meta分析。结果：共纳入2项Ⅲ期RCT研究（ZUMA-7、TRANSFORM），各结局指标均根据异质性检验结果选择固定效应模型合并数据。疗效方面，CD19 CAR-T细胞疗法可显著改善患者无事件生存期（HR=0.455，95%CI：0.363~0.570，P < 0.001）和降低死亡风险（HR = 0.738，95%CI：0.575~0.947，P = 0.017）；同时可显著提高完全缓解率（RR = 1.879，95%CI：1.574~2.242，P < 0.001）。按产品类型的探索性分析显示，liso-cel和axi-cel均优于标准治疗（liso-cel：HR = 0.380，95%CI：0.260~0.540，P < 0.001；axi-cel：HR = 0.510，95%CI：0.380~0.680，P < 0.001），但该分析为不同试验间的对比，证据等级有限。安全性结局显示：CAR-T细胞疗法的免疫效应细胞相关神经毒性综合征（ICANS）发生率显著升高（RR = 22.387，95%CI：4.353~115.132，P < 0.001）；≥3级细胞因子释放综合征（CRS）发生率数值升高（RR = 8.181，95%CI：0.935~71.574，P = 0.058），差异无统计学意义。纳入研究的偏倚风险整体为低；敏感性分析证实结果稳健。结论：基于2项RCT的Meta分析结果，CD19 CAR-T细胞（liso-cel/axi-cel）可作为R/R DLBCL二线治疗的选择之一，其疗效优于标准治疗，且特征性不良反应（CRS/ICANS）经规范管理后可控，可根据患者基线状态个体化选择CAR-T细胞产品。本研究证据基础薄弱，上述结论尚需更多高质量、大样本RCT验证。

【Objective】To observe macular choroidal thickness and topographical variation in Chinese healthy and myopic children and to investigate the correlated factors. 【Methods】 A total of 196 myopic children treated at Hainan Province Eye Hospital were selected and divided into hyperopia ，emmetropia，low，moderate and severe myopia groups according to their spherical equivalents（SE）. Axial length（AXL），subfoveal choroidal thickness（SFCT）and 1 mm ，3 mm nasal，temporal，superior，and inferior to the foveal choroidal thickness were recorded. Forty- five students from Tung Wah Group of Hospital′s MA Kam Chan Memorial Primary School in Hong Kong were also recruited in this 1-year longitudinal study. Children were grouped to myopic group and emmetropic or hyperopic group according to SE ，thickness changes of choroid were compared among children with or without myopic shift. The correlation among choroidal SE，and AXL variations were also investigated.【Results】Mean SFCT was 250（204~314）μm. The choroid was thinner at the nasal and inferior sectors ，the thinnest being at 3mm nasal to the fovea ，and the thickest at 1mm temporal to the fovea. Choroidal thickness in all orientations became thinner with progressively descending refractive degree. SFCT and 1 mm around fovea decreased most compared with other surrounding directions in all groups（Kruskal- Wallis test，P < 0.05）. The choroidal thickness in subfovea and other sectors got thinned after 1 year follow-up time（Pair t test，P < 0.05）.The variation of the choroidal thickness in fovea and surrounding positions was positively correlated with the change of SE and negatively related to the change of the AXL. The myopic group had a faster descent of SE and a faster growth of AXL than the emmetropic or hyperopic group. SFCT and surrounding choroidal thickness showed a progressive descent in the myopic group，but a slight decrease in the emmetropic or hyperopic groups.【Conclusions】There is significant topographic variation of choroidal at different regions of the macular. The choroidal thickness decreases faster in myopes. SFCT is more sensitive to myopic progression compared with surrounding regions.