细胞移植治疗晚期脊髓损伤的Meta分析

Cell transplantation for the treatment of advanced-stage spinal cord injury:A Meta analysis

背景:脊髓损伤后的神经再生和功能恢复一直是医学界研究的热点和难点。近几年随着研究的深入,细胞移植作为一种新的治疗方法,已经取得了一定的研究成果,但其临床疗效仍存在争议,目的:应用循证医学Meta分析来评价细胞移植治疗晚期脊髓损伤的疗效。方法:检索Cochrane图书馆(2010年第4期)、PubMed(1966/2010)、EM base(1989/2010)、中国生物医学文献数据库(1978/2010)、万方数据库(1982/2010),纳入有关于细胞移植治疗晚期脊髓损伤患者的研究,两名调查员独立对文献质量进行严格评价和资料提取。脊髓损伤的患者接受细胞移植前后的美国脊髓损伤协会评分,包括运功、轻触觉、针刺觉。结果与结论:共纳入7篇队列研究,共388例患者。Meta分析结果显示,脊髓损伤的患者细胞移植前后美国脊髓损伤协会功能评分差异有显著性意义(P<0.00001)。美国脊髓损伤协会运动评分移植前后差异有显著性意义[WMD=6.14,95%CI(3.43,8.85),P<0.00001],美国脊髓损伤协会轻触觉评分差异有显著性意义[WMD=8.63,95%CI(5.61,11.66),P<0.00001],美国脊髓损伤协会针刺觉评分差异有显著性意义[WMD=10.65,95%CI(7.58,13.72),P<0.00001]。细胞移植后无严重并发症。提示细胞移植可以作为晚期脊髓损伤的一种治疗手段,但是疗效和安全性仍需大样本的随机对照试验来验证。

BACKGROUND：Neural regeneration and functional recovery following spinal cord injury（SCI） is still a hot focus and difficulty in the medical circle.Recently,cell transplantation as a new therapeutic method with deep research has obtained study outcomes,but its clinical curative effect remains controversial.OBJECTIVE：To evaluate the effectiveness of cell transplantation for the treatment of advanced-stage SCI by meta-analyses.METHODS：Cochrane Database（Issue 4,2010）,PubMed（1966-2010）,EMbase（1989-2010）,Chinese Biomedical Literature Database（1978-2010）,Wanfang Database（1982-2010） were searched to identify the literatures.All studies about cell transplantation for the treatment of advanced-stage SCI were adopted;the quality of researches was critically appraised and data were extracted by 2 investigators independently.It was collected that the patients＇ American Spinal Injury Association scores of pre-operation and post-operation,including motor score,light touch and pinprick.RESULTS AND CONCLUSION：Seven cohort studies involving 388 patients were collected.The results of Meta-analyses showed that the difference of American Spinal Injury Association scores between pre-operation and post-operation had statistical significance（P 0.000 01）.The mean increase in ASIA motor scores was 6.14 [95%CI（3.43,8.85）,P 0.000 01],and the mean increase for light touch was 8.63 [95%CI（5.61,11.66）,P 0.000 01] and the mean increase for pinprick was 10.65 [95%CI（7.58,13.72）,P 0.000 01].There were no severely adverse effects after cell transplantation.Cell transplantation could be a treatment method for advanced-stage SCI,but the effectiveness and safety required being proved by the randomized controlled trials of large sample.