干细胞移植改善慢性心力衰竭患者心脏重构、降低心脏相关不良事件的荟萃分析

A meta-analysis on the efficacy of stem cells transplantation therapy on the prevention of cardiac remodeling and main adverse cardiovascular event in patients with chronic heart failure

目的干细胞移植治疗梗死后心力衰竭是心脏病学的重大进展之一，本研究采用荟萃分析的方法对比骨髓来源的单个核细胞（BMC）移植治疗和单纯使用基础药物治疗心肌梗死后慢性心力衰竭患者心脏重构的疗效及其安全性，为干细胞的移植治疗提供依据。方法计算机检索Cochrane图书馆临床对照试验数据库（2011年第4期）、PubMed数据库、荷兰医学文摘（Embase）数据库、Medline数据库、中文生物医学文献数据库、中文生物医学期刊引文数据库、中国期刊全文数据库、中文科技期刊数据库、万方数据库、重庆维普数据库（建库至2011年12月）。纳入的研究为随机对照临床试验，对象为单个随机对照临床研究。临床试验组的干预措施为BMC移植治疗，而对照组为积极的药物治疗。综合的方式方法：从数据库中检索出具体的单个临床研究，从中提取出需要的数据，按照纳入与排除标准选择文献并评价，采用Stata11．0软件进行荟萃分析。结果共纳入临床研究31个，患者2375例。荟萃分析结果显示BMC移植患者左心室舒张末容积改善程度较单纯药物治疗患者显著[SMD=-11．8％（95％CI-0．223～0．013），P=0．027]，且其发生心脏事件的相对风险度较单纯药物治疗患者更低[RR=0．77（95％C10．66～0．90），P〈0．01]。结论BMC移植治疗可以改善慢性心力衰竭患者心脏重构，且安全可行。

Objective Stem cells transplantation is a promising strategy in cardiology. This meta- analysis summarizes the efficacy and safety of stem cells transplantation on top of standard medication on chronic heart failure patients. Methods The following databases were searched, including Coehrane Library （ Issue 4,2011 ）, PubMed （ 1980 to 2011 ）, Embase （ 1990 to 2011 ）, CBM （ 1978 to 2011 ）, CNKI （ 1994 to 2011 ）, VIP （ 1989 to 2011 ）, and WanFang Data （ 1998 to 2011 ）. Search criteria： studies were screened and the quality was evaluated according to predefined inclusion and exclusion criteria. Intervention measures：the treatment group using stem cell transplantation therapy on top of standard drug treatment, while the control group using standard drug treatments. Results A total of 31 studies involving 2375 patients were included. The results show that the improvement of LVEDV in the stem cell treatment group is greater than in the control group [ SMD = - 11.8% （95% CI： - O. 223 - 0. 013 ）, P = 0. 027 ] and the relative-risk of cardiac events is lower in stem cell treatment group [RR =0. 77（95% CI：0. 66 -0. 90） ,P 〈0. 01 ] than in control group. Conclusion Stem cells therapy is effective in improving cardiac remodeling and reducing the relative-risk of cardiac events in patients with chronic heart failure.