Mesenchymal stem cell transplantation improves the prognosis of ischemic stroke: a Meta-analysis

doi:10.3969/j.issn.2095-4344.0448

Abstract

Abstract:

BACKGROUND: Mesenchymal stem cell (MSC) transplantation has been gradually developed to improve the prognosis of cerebral infarction and its sequelae in clinical trials, which has been identified as effective and safe. A small sample size, however, results in the lack of evidence-based medical evidence.
OBJECTIVE: To systematically review the efficacy of MSC transplantation on the prognosis of cerebral infarction.
METHODS: In order to collect randomized controlled trials (RCTs) of MSC transplantation for the prognosis of cerebral infarction, we searched Cochrane Library, PubMed, Ovid, CBM, CNKI, WanFang, and VIP Data from its inception to November 2016. Articles addressing MSCs transplantation alone or with conventional drug treatment and/or rehabilitation training versus conventional drug treatment alone or with rehabilitation training were included. Two authors independently screened the literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias. Thereafter, qualitative description and Meta-analysis were performed.
RESLUTS AND CONCLUSION: Ten RCTs involving 626 cerebral infarction patients were included in the Meta-analysis. The results showed that the MSCs group was superior to the control group with statistical significance in the daily life ability (Barthel index) [MD=20.06, 95%CI(9.95, 30.18), P=0.000 1], motor function (Fugl-Meyer scale) [MD=14.60, 95%CI(12.96, 16.25), P < 0.000 01], personal disability (functional independent measure) [MD=15.16, 95%CI(9.06, 21.26), P < 0.000 01] and neurological deficit score (National Institute of Health stroke scale) [MD=-2.59, 95%CI(-3.14,-2.05), P < 0.000 01]. Low fever and mild headache were reported by four included studies, and waist pain was only by one study, but these symptoms went away by themselves or after symptomatic treatment. Subgroup analysis suggested that MSCs from the bone marrow were superior to those from the umbilical cord and cord blood, but showed a greater heterogeneity. It is suggested that the MSC transplantation ameliorate the prognosis in patients with cerebral infarction, significantly improve the activities of daily living, motor function, personal disability and neurological function, with no presence of serious adverse effects. However, high-quality studies with large sample size are required for further investigation on the clinical application of MSC transplantation.

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: Brain Infarction, Mesenchymal Stem Cell Transplantation, Meta-Analysis, Tissue Engineering

CLC Number:

R394.2

Xu Fan, Lei Ming, Long Long, Gong Qi-hai, Gao Jian-mei. Mesenchymal stem cell transplantation improves the prognosis of ischemic stroke: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(5): 760-765.

Figures/Tables 4

2.4 间充质干细胞移植组对比对照组Meta分析结果 2.4.1 日常生活活动功能改善共3项研究报道了间充质干细胞(来源均为自体骨髓)移植前及移植3个月后脑梗死患者日常生活能力改善的BI评分[11，15，18]。由于各研究具有统计学上的异质性(P=0.03，I2=73%)，故采取随机效应模型对研究进行Meta分析。结果表明，间充质干细胞移植组日常生活能力的改善度要显著优于对照组[MD=20.06，95%CI(9.95，30.18)，P=0.000 1]，见图2。 2.4.2 运动功能改善共5个研究报道了间充质干细胞(3个为自体骨髓来源，1个为脐带组织来源，1个为脐血来源)移植前及移植3个月后患者运动功能的Fugl-Meyer评分[13-14，16-17，19]。由于1个随机对照试验数据未提供明确，故只纳入4个研究进行分析，各研究之间没有统计学上的异质性(P=0.14，I2=45%)，对研究采取固定效应模型Meta分析，结果表明，间充质干细胞移植组患者运动功能改善度优于对照组，其差异有显著性意义[MD=14.60，95%CI (12.96，16.25)，P < 0.000 01]，见图3。 2.4.3 个体残疾状态改善 4个研究报道了间充质干细胞(2个为自体骨髓来源，2个为脐带组织来源)移植前及移植3个月后患者运动功能的FIM评分[13-14，16，20]。对研究采用随机效应模型Meta分析，结果表明，间充质干细胞移植组脑梗死患者个体残疾状态改善度显著优于对照组[MD=15.16，95%CI(9.06，21.26)，P < 0.000 01]，见图4。 2.4.4 神经功能缺损改善 4个研究报道了间充质干细胞(3个为自体骨髓来源，1个为脐血来源)移植前及移植3个月后患者NIHSS评分[15，17-19]。对研究采取固定效应模型进行Meta分析结果表明，间充质干细胞移植组脑梗死患者神经功能的缺损改善度显著优于对照组[MD=-2.59，95%CI (-3.14，-2.05)，P < 0.000 01]，见图5。"

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