自体骨髓干细胞移植治疗慢性缺血性心脏病患者的有效性

Efficacy of autologous bone marrow-derived cells transfer for patients with chronic ischemic heart disease： a meta-analysis

目的 对自体骨髓干细胞（bone marrow-derived cells,BMC）移植治疗慢性缺血性心脏病的有效性进行荟萃分析.方法 全面检索MEDLINE、EMBASE、Cochrane等数据库,人选研究满足以下条件：体现随机对照原则;以慢性缺血性心脏病患者为研究对象;移植细胞为非动员的自体BMC;BMC移植方式为经冠状动脉移植或直接心肌内注射.提取有关左心室射血分数、左心室舒张末期容积/腔径、左心室收缩末期容积/腔径及患者死亡的信息.应用RevMan 5.0软件及随机效应模型进行数据统计,应用STATA 10.0软件进行Meta回归分析评价异质性的来源;此外,亚组分析比较直接心肌内注射和经冠状动脉注射2种移植方式对移植效果的影响.结果 11项随机对照研究共纳入490例,其中移植组268例,对照组222例,平均随访6.6个月,移植组接受经冠状动脉或直接心肌内注射BMC,对照组接受生理盐水注射、自体血浆注射或不接受任何处理.与对照组相比,BMC移植组左室射血分数较对照组高4.63%（95%C/：2.42～6.84,P〈0.01）,而左心室舒张末期容积/腔径（标化均差-0.55,95%CI：-0.94～-0.17;P=0.005）和左心室收缩末期容积/腔径（标化均差-0.45,95%CI：-0.73～-0.17;P=0.002）均低于对照组.此外,移植组患者死亡也低于对照组（OR=0.42,95%CI：0.18～1.01,P=0.05）.亚组分析显示直接心肌内注射较经冠状动脉移植更好地改善患者LVEF,Meta回归分析提示基线LVEF值越低的患者从自体BMC移植中获得的益处越大.结论 BMC移植治疗可显著改善慢性缺血性心脏病患者的LVEF,有效预防左心室舒张、收缩末期容积/腔径的扩大.

Objective We aimed to perform a meta-analysis of clinical trials on the efficacy of autologous bone marrow-derived cells （ BMCs ） transfer for patients with chronic ischemic heart disease. Methods We searched MEDLINE, EMBASE, and Cochrane database through September 2009. Eligible studies were randomized controlled trials of autologous BMCs infusion in patients with chronic ischemic heart disease. We gathered information about left ventricular ejection fraction （LVEF）, left ventricular end-diastolic volume （LVEDV） , left ventricular end-systolic volume （ LVESV） and death, and did a randomeffect meta-analysis to obtain summary effect estimates for outcomes. The pooled analyses were performed and forest plots were generated with RevMan 5. 0 software. Heterogeneity was assessed by meta-regression with STATA 10. 0 software. Additionally, subgroup analysis was performed to compare the effect of intracoronary BMCs transfer with intramyocardial cell injection on LVEF. Results Eleven trials with 490 participants were identified. There were 268 patients in BMCs group, and 222 in control group. In control group, the patients received saline injection or autologous plasma injection or no injection. BMCs transfer was performed via intracoronary transfer or intramyocardiac injection. Compared with controls, BMCs transfer significantly improved LVEF by 4. 63% （95% CI 2. 42 to 6. 84; P 〈 0.01 ） . BMCs transfer was also associated with significant reductions in LVEDV （standardized mean difference -0. 55,95% CI -0.94 to -0. 17,P = 0. 005 ） and LVESV （ standardized mean difference -0. 45,95% CI - 0. 73 to - 0. 17, P = 0. 002）. In addition, BMCs treatment was associated with a significant effect on death （ OR 0.42,95% CI 0. 18 to 1.01 ,P =0. 05）. Subgroup analysis indicated that intramyocardial cell injection was preferred due to its more significant improvement of LVEF than intracoronary cell therapy. Meta-regression suggested the existence of a negative association between baseline LVEF and LVEF change. Conclusion BMCs infusion is associated with a significant improvement in LVEF, and an attenuation of left ventricular remodeling.