中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (5): 780-788.doi: 10.3969/j.issn.2095-4344.2017.05.021

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

自体骨髓间充质干细胞治疗扩张性心肌病：安全和有效性的Meta分析

艾金伟1，2，3，刘  盈1，刘楚繁1，裴  斌1，2，3   

  1. 湖北医药学院附属襄阳医院，1循证医学中心，2生物治疗科，3骨科，湖北省襄阳市  442000
  • 出版日期:2017-02-18 发布日期:2017-03-20
  • 通讯作者: 裴斌，硕士生导师，主任医师，教授，湖北医药学院附属襄阳医院，循证医学中心，生物治疗科，骨科，湖北省襄阳市 442000
  • 作者简介:艾金伟，男，1984年生，湖北省十堰市人，汉族，硕士，主治医师，主要从事循证医学、干细胞基础与临床运用、骨关节病防治研究。 并列第一作者：刘盈，女，1972年生，湖北省襄阳市人，硕士，副主任护师，主要从事骨科护理学、干细胞基础与临床运用研究。
  • 基金资助:

    湖北省卫生计生西医类2015-2016年度一般项目(WJ2015MB187)；湖北医药学院教研重点项目(2015025)

Safety and efficacy of autologous bone marrow mesenchymal stem cells for dilated cardiomyopathy: a Meta-analysis

Ai Jin-wei1, 2, 3, Liu Ying1, Liu Chu-fan1, Pei Bin1, 2, 3   

  1. 1Evidence-Based Medicine Center, 2Department of Biotherapy, 3Department of Orthopedics, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 442000, Hubei Province, China
  • Online:2017-02-18 Published:2017-03-20
  • Contact: Pei Bin, Master’s supervisor, Chief physician, Professor, Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 442000, Hubei Province, China
  • About author:Ai Jin-wei, Master, Attending physician, Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 442000, Hubei Province, China Liu Ying, Master, Associate chief nurse, Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 442000, Hubei Province, China Ai Jin-wei and Liu Ying contributed equally to this work.
  • Supported by:

    the General Project for Western Medicine of Hubei Province in 2015-2016, No. WJ2015MB187; the Key Teaching and Research Project of Hubei University of Medicine, No. 2015025

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摘要：

文章快速阅读：

文题释义：
自体骨髓间充质干细胞移植治疗扩张性心肌病的作用机制：①骨髓间充质干细胞在适当的条件下能增殖、分化为心肌样细胞，分化的心肌样细胞有肾上腺能受体和胆碱能受体β1、β2、M1、M2表达，并且能表达心肌组织特有的肌球蛋白重链、收缩蛋白和连接蛋白43，因此具有心肌纤维的收缩性，能与原心肌细胞实现收缩功能的整合；②骨髓间充质干细胞可以分化成血管平滑肌细胞和内皮细胞及其细胞生长因子，促进心肌血管及毛细血管网新生，增加心肌供血；③骨髓间充质干细胞通过旁分泌或上调周边细胞产生多种活性细胞因子，促进心肌修复和心功能改善；④骨髓间充质干细胞通过增殖、分化参与维护心室壁厚度及弹性，抑制心室重构和扩张；⑤骨髓间充质干细胞具有免疫调节作用，通过分泌抗炎性因子，降低肿瘤坏死因子和白细胞介素6水平，从而延缓病情进展，增加患者生存率。

 

摘要
背景：自体骨髓间充质干细胞已被用于扩张性心肌病的临床治疗，但其安全性和有效性存在争议。
目的：运用Meta分析方法评价自体骨髓间充质干细胞移植治疗扩张性心肌病的安全性和有效性。
方法：系统检索PubMed、Cochrane Library(2016年第2期)、Embase、CNKI、CBM、维普、万方数据库中，有关自体骨髓间充质干细胞移植与常规药物治疗扩张性心肌病的临床随机对照试验。运用R3.1.0软件对两种治疗后的左室射血分数、左室舒张末期内径、6 min步行距离、心肌灌注缺损面积百分比、治疗及随访过程中患者死亡率、恶性心律失常发生率及心脏移植率进行Meta分析。
结果与结论：纳入7个随机对照试验，合计341例扩张性心肌病患者。Meta分析结果显示：与常规药物疗法相比，自体骨髓间充质干细胞移植能增加扩张性心肌病患者左心室射血分数[1个月：MD=3.02，95%CI(1.55，4.49)；3个月：MD=4.38，95%CI(3.55，5.52)；6个月：MD=6.47，95%CI(4.78，8.15)；≥12个月：MD=8.23，95%CI(5.15，9.19)]，降低治疗3个月后的左室舒张末期内径[3个月：MD=-0.65，95%CI(-0.72，-0.59)；6个月：MD=-0.12，95%CI(-0.21，-0.03)；≥12个月：MD=-0.19，95%CI(-0.24，-0.13)]，增加治疗6个月后6 min步行距离[6个月：MD=87.70，95%CI(51.55，123.85)；≥12个月：MD=143.83，95%CI(122.73，164.93)]，降低治疗3个月的心肌灌注缺血面积百分比[MD=-3.56，95%CI(-5.57，-1.55)]，降低治疗及随访期间死亡率[RR=0.46，95%CI(0.24，0.89)]；两种治疗在降低恶性心律失常及心脏移植率上无明显差异。研究结果提示，自体骨髓间充质干细胞移植治疗扩张性心肌病疗效优于常规药物疗法，且安全性良好。

 

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
ORCID: 0000-0003-0547-5964(裴斌)

关键词: 干细胞, 骨髓干细胞, 扩张型心肌病, 细胞移植, 安全性, 有效性, Meta分析

Abstract:

BACKGROUND: Autologous bone marrow mesenchymal stem cells (BMSCs) transplantation has been used for clinical treatment of dilated cardiomyopathy. But the efficacy and safety of autologous BMSCs transplantation remains controversial.
OBJECTIVE: To systematically assess the efficacy and safety of autologous BMSCs transplantation for treatment of dilated cardiomyopathy by using meta-analysis approach.
METHODS: PubMed, Cochrane Library (Issue 2, 2016), Embase, CNKI, CBM, VIP, WanFang were systemically searched for relevant randomized controlled trials (RCTs) about autologous BMSCs transplantation and conventional drugs for the treatment of dilated cardiomyopathy. After information extracting and quality assessing, Meta-analysis of left ventricular ejection fraction, left ventricular end-diastolic diameter, 6-minute walking distance, percentage of myocardial perfusion defect, mortality, incidence of malignant arrhythmia events and heart transplantation rate during treatment and follow-up was performed using R3.1.0 software.
RESULTS AND CONCLUSION: A total of 7 RCTs involving 341 patients were included. Meta-analysis results showed that for efficacy, compared with the conventional drugs, BMSCs can increase the left ventricular ejection fraction [1 month post-treatment: mean difference (MD)=3.02, 95% confidence interval (CI) (1.55, 4.49); 3 months post-treatment: MD=4.38, 95%CI(3.55, 5.52); 6 months post-treatment: MD=6.47, 95%CI(4.78, 8.15); ≥ 12 months post-treatment: MD=8.23, 95%CI(5.15, 9.19)]; decrease the left ventricular end-diastolic diameter after 3 months [3 months post-treatment: MD=-0.65, 95%CI(-0.72, -0.59); 6 months post-treatment: MD=-0.12, 95%CI(-0.21, -0.03); ≥ 12 months post-treatment: MD=-0.19, 95%CI(-0.24, -0.13)]; increase 6-minute walking distance after 6 months [6 months post-treatment: MD=87.70, 95%CI(51.55, 123.85); ≥ 12 months post-treatment: MD=143.83, 95%CI(122.73, 164.93)]; and decrease percentage of myocardial perfusion defect at 3 months [MD=-3.56, 95%CI(-5.57, -1.55)]. For safety, BMSCs can decrease the mortality [risk ratio=0.46, 95%CI(0.24, 0.89)], but there is no significant difference in the incidence of malignant arrhythmia events and heart transplantation rate between two treatment groups. To conclude, these results indicate that BMSCs transplantation for dilated cardiomyopathy is one of effective and safe treatments.

 

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

Key words: Cardiomyopathy, Dilated, Stem Cells, Cell Transplantation, Meta-Analysis, Tissue Engineering

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