中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (7): 1085-1092.doi: 10.12307/2022.149

• 干细胞循证医学 evidence-based medicine of stem cells • 上一篇    下一篇

间充质干细胞不同移植途径治疗缺血性脑卒中疗效差异的系统评价

房晓磊¹,冷  军²,张  晨¹,刘会敏¹,郭  文¹   

  1. 1山东中医药大学,山东省济南市  250355;2山东中医药大学第二附属医院,山东省济南市  250001
  • 收稿日期:2021-04-26 修回日期:2021-04-27 接受日期:2021-05-26 出版日期:2022-03-08 发布日期:2021-10-29
  • 通讯作者: 冷军,副主任医师,山东中医药大学第二附属医院,山东省济南市 250001
  • 作者简介:房晓磊,男,1996年生,山东省临沂市人,汉族,山东中医药大学在读硕士。
  • 基金资助:
    国家中医药管理局科研基金(JDZX201915),项目分中心负责人:冷军

Systematic evaluation of different therapeutic effects of mesenchymal stem cell transplantation in the treatment of ischemic stroke

Fang Xiaolei¹, Leng Jun², Zhang Chen¹, Liu Huimin¹, Guo Wen¹   

  1. 1Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China; 2Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, Shandong Province, China
  • Received:2021-04-26 Revised:2021-04-27 Accepted:2021-05-26 Online:2022-03-08 Published:2021-10-29
  • Contact: Leng Jun, Associate chief physician, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, Shandong Province, China
  • About author:Fang Xiaolei, Master candidate, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • Supported by:
    Research Fund of National Administration of Traditional Chinese Medicine, No. JDZX201915 (to LJ)

摘要:

文题释义:
间充质干细胞:泛指一类来源于骨髓、脂肪及脐带等组织,具有一定分化潜能的细胞群。
干细胞移植治疗:是把健康的干细胞移植到患者体内,以达到修复或替换受损细胞或组织,从而达到治疗疾病的目的。
目的:系统评价间充质干细胞治疗缺血性脑卒中的疗效和安全性,比较不同间充质干细胞移植途径临床疗效的差异。
方法:计算机检索PubMed、中国知网、万方数据、维普、Web of Science及SinoMed数据库,搜集2005年1月至2021年3月的间充质干细胞治疗缺血性脑卒中的随机对照试验,对照组采用常规治疗,干细胞组采用间充质干细胞移植治疗。利用Cochrane协作网推荐的偏倚评估工具对纳入的文献进行文献质量评估。利用RevMan 5.3和Stata 16.0软件对纳入的主要结局指标为神经功能缺损评分(National institute of health stroke scale,NIHSS),次要结局指标为改良Rankin量表(Modified Rankin scale,mRS)评分、功能独立性(Function independent measure,FIM)评分、运动功能(Fugl-meyer assessment,FMA)评分、日常生活能力(Barthel index,BI)评分和治疗后的不良结局进行荟萃分析,对神经功能缺损NIHSS评分进行网状Meta分析。
结果:最终纳入17项随机对照试验,共纳入936例缺血性脑卒中病例,文献质量整体一般。①直接Meta分析结果显示,间充质干细胞在降低神经功能缺损NIHSS评分和mRS评分,提高FMA运动功能评分、日常生活能力BI评分、功能独立性FIM评分方面优于常规治疗组(P < 0.05)。②网状Meta分析结果显示,与常规治疗组相比,经蛛网膜下腔注射结合静脉注射可以显著降低NIHSS评分(P < 0.05),促进神经功能恢复;SUCRA累计概率图排序:经蛛网膜下腔注射结合静脉注射(79.0%)>立体定向植入(71.3%)>经蛛网膜下腔注射(55.8%)>静脉注射(43.0%)>颈动脉注射(36.5%)>常规治疗(14.4%);经蛛网膜下腔注射结合静脉注射较其他移植方式效果更好。
结论:间充质干细胞可以有效改善缺血性脑卒中患者的神经功能,提高运动功能、日常生活能力以及功能独立性,且间充质干细胞移植较为安全。经蛛网膜下腔注射结合静脉注射可能是间充质干细胞移植提高缺血性脑卒中后神经功能的最佳途径。

https://orcid.org/0000-0002-1767-7769 (房晓磊) ;https://orcid.org/0000-0001-8622-2760 (冷军)

中国组织工程研究杂志出版内容重点:干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程


关键词: 干细胞, 干细胞移植, 间充质干细胞, 脑卒中, 脑梗死, 骨髓间充质干细胞, 脐带血间充质干细胞, 外周血干细胞

Abstract: OBJECTIVE: To conduct a meta-analysis of the efficacy and safety of mesenchymal stem cells in the treatment of ischemic stroke and to compare the clinical efficacy of different mesenchymal stem cells transplantation pathways. 
METHODS: PubMed, CNKI, Wanfang data, VIP, Web of Science, and SinoMed were searched, and randomized controlled trials of mesenchymal stem cells in the treatment of ischemic stroke published from January 2005 to March 2021 were collected. The control group received conventional treatment. The stem cell group received mesenchymal stem cell transplantation. The literature quality was assessed using the bias assessment tool recommended by the Cochrane Collaboration. The included primary outcome measures National Institute of Health Stroke Scale score, secondary outcome index modified Rankin Scale score, function independent measure score, Fugl-Meyer assessment score, Barthel index score, and post-treatment adverse outcome were analyzed using RevMan 5.3 and Stata 16.0 software. The network meta-analysis was performed for the National Institute of Health Stroke Scale score of neurological impairment.
RESULTS: Seventeen randomized controlled trials were included, and the quality of the included articles was generally average. A total of 936 ischemic stroke cases were included. (1) Results of meta-analysis showed that mesenchymal stem cells were superior to conventional treatment group in reducing National Institute of Health Stroke Scale score and modified Rankin Scale score of neurological impairment, improving Fugl-Meyer assessment motor function score, Barthel index score of daily living ability, and functional independence Function independent measure score (P < 0.05). (2) The results of network meta-analysis showed that compared with the conventional treatment group, subarachnoid injection combined with intravenous injection could significantly reduce the National Institute of Health Stroke Scale score (P < 0.05) and promote the recovery of neurological function. SUCRA cumulative probability: Subarachnoid injection combined with intravenous injection (79.0%) > stereotactic implantation (71.3%) > subarachnoid injection (55.8%) > intravenous injection (43.0%) > carotid injection (36.5%) > routine treatment (14.4%). The effect of subarachnoid injection combined with intravenous injection was better than other transplantation methods.
CONCLUSION: Mesenchymal stem cells can effectively improve neurological function, improve motor function, daily living ability and functional independence in patients with ischemic stroke, and mesenchymal stem cell transplantation is relatively safe. The combination of subarachnoid injection and intravenous injection may be an optimal path to improve the neural function of mesenchymal stem cell transplantation after ischemic stroke.


Key words: stem cells, stem cell transplantation, mesenchymal stem cells, stroke, cerebral infarction, bone marrow mesenchymal stem cells, umbilical cord mesenchyma stem cells, peripheral blood stem cells

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