中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (1): 76-82.doi: 10.12307/2022.981

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

间充质干细胞治疗缺血性脑卒中安全性与疗效的Meta分析

胡  斐1,王  洁2   

  1. 1山西医科大学研究生院,山西省太原市   030001;2山西医科大学第一医院,山西省太原市   030001
  • 收稿日期:2021-11-20 接受日期:2021-12-31 出版日期:2023-01-08 发布日期:2022-06-14
  • 通讯作者: 王洁,博士,主任医师,山西医科大学第一医院,山西省太原市 030001
  • 作者简介:胡斐,男,1992年生,山西省运城市人,2020年山西医科大学毕业,硕士,主要从事脑血管病研究。

Safety and efficacy of mesenchymal stem cells in the treatment of ischemic stroke: a meta-analysis

Hu Fei1, Wang Jie2   

  1. 1Graduate School of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Received:2021-11-20 Accepted:2021-12-31 Online:2023-01-08 Published:2022-06-14
  • Contact: Wang Jie, MD, Chief physician, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • About author:Hu Fei, Master, Graduate School of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China

摘要:

文题释义:
间充质干细胞:起源于中胚层细胞,其增殖能力强、分化谱系多,可在不同诱导条件下分化为成骨细胞、软骨细胞、肌细胞、基质细胞、神经细胞等,还具有免疫调节等功能。
脑卒中:是一种急性脑血管疾病,由于脑部血管突然破裂或因血管阻塞导致血液不能流入大脑而引起脑组织损伤的一组疾病,包括缺血性卒中和出血性卒中。缺血性卒中的发病率高于出血性卒中,占脑卒中总数的60%-70%。

目的:通过系统评价明确间充质干细胞治疗缺血性脑卒中的安全性与疗效,并提供相关循证医学证据。
方法:计算机检索中文数据库(中国知网、万方、维普)以及英文数据库(PubMed、The Cochrane Library、Embase)有关间充质干细胞治疗脑卒中的临床对照试验,检索时间限定到2021-09-30,以美国国立卫生研究院卒中量表评分、日常生活能力指数、运动功能评分、功能独立性评分、改良Rankin评分为结局指标,由2名研究员独立进行文献筛选、数据提取及研究质量评估,其中随机对照试验采用“Cochrane偏倚风险评估工具”评估质量,并使用stata 15.0进行Meta分析、敏感性分析以及森林图的制作等。
结果:纳入20个随机对照试验,共1 127例缺血性脑卒中患者,文献总体质量较高。Meta分析结果显示:治疗3个月时,间充质干细胞组美国国立卫生研究院卒中量表评分、运动功能评分、功能独立性评分优于对照组[WMD=-2.12(95%CI:-2.66至-1.58,Z=7.70,P < 0.001),WMD=14.34(95%CI:12.99-15.68,Z=20.90,P < 0.001),WMD=20.94(95%CI:9.28-22.59,Z=5.88,P < 0.001)]。而日常生活能力指数、改良Rankin评分两组效果接近[WMD=6.98(95%CI:-2.89-16.85,Z=1.39,P=0.166),WMD=-0.04(95%CI:-0.16-0.24,Z=0.44,P=0.663)]。其他各时点,除改良Rankin评分外,美国国立卫生研究院卒中量表评分、日常生活能力指数、运动功能评分、功能独立性情况评分均有显著改善。
结论:间充质干细胞移植能在一定程度上改善缺血性脑卒中患者的神经功能缺损、运动功能、日常生活能力。

https://orcid.org/0000-0001-8677-467X (王洁)

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: 间充质干细胞, 缺血性脑卒中, 中风, 运动功能, 日常生活, 移植, 神经功能, Meta分析

Abstract: OBJECTIVE: To systematically evaluate the safety and efficacy of mesenchymal stem cells in the treatment of ischemic stroke, and to provide relevant evidence-based medicine evidence. 
METHODS: Clinical controlled trials of mesenchymal stem cells in the treatment of stroke were searched from Chinese databases (CNKI, Wanfang, and VIP) and English databases (PubMed, The Cochrane Library, and Embase) for articles published until September 30, 2021. The United States National Institutes of Health Stroke Scale score, Barthel index, Fugl-Myer movement assessment score, functional independence measure score, and Modified Rankin Scale score were used as outcome measures. Literature screening, data extraction and research quality assessment were conducted independently by two researchers. The qualities of randomized controlled trials were assessed using Cochrane bias risk assessment tool. Stata 15.0 was used for meta-analysis, sensitivity analysis and forest plot making. 
RESULTS: A total of 1 127 patients with ischemic stroke were included from 20 randomized controlled trials. The overall quality of the literature was high. Meta-analysis results showed that the scores of National Institutes of Health Stroke Scale, Fugl-Myer movement assessment and functional independence measure score in the mesenchymal stem cell group were better than those in the control group after 3 months of treatment [WMD=-2.12(95%CI:-2.66 to -1.58, Z=7.70, P < 0.001), WMD=14.34(95%CI:12.99-15.68, Z=20.90, P < 0.001), WMD=20.94(95%CI:9.28-22.59, Z=5.88, P < 0.001)]. Barthel index and Modified Rankin Scale score were similar between the two groups [WMD=6.98(95%CI:-2.89-16.85, Z=1.39, P=0.166), WMD=-0.04(95%CI:-0.16 to 0.24, Z=0.44, P=0.663)]. Except for Modified Rankin Scale score, the scores of National Institutes of Health Stroke Scale, Barthel index, Fugl-Myer movement assessment and functional independence measure score were significantly improved at all other time points. 
CONCLUSION: Mesenchymal stem cell transplantation can improve the neurological deficit, motor function and daily living ability of patients with ischemic stroke.

Key words: mesenchymal stem cell, ischemic stroke, stroke, motor function, daily life, transplantation, neurological function, meta-analysis

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