自体外周血干细胞经冠状动脉移植治疗心肌梗死的Meta分析

Autologous transplantation of peripheral blood stem cells for myocardial infarction:a meta analysis

目的系统评价自体外周血干细胞(PBSC)冠状动脉移植治疗心肌梗死的有效性和安全性。方法计算机检索PubMed(1966年1月至2013年6月)、EMbase(1974年1月至2013年6月)、ISI Web of Knowledge(1945年1月至2013年6月)、Cochrane Library(2013年第6期)、CBM(1978年1月至2013年6月)、VIP(1989年1月至2013年6月)、CNIKI(1915年1月至2013年6月)及WanFang Data(1996年1月至2013年6月),并辅以手工检索,收集国内外发表的相关随机对照试验(RCT)。两位研究者按照纳入标准筛选文献、提取资料,按照改良Jadad评分表评价纳入研究质量,采用RevMan5.2进行Meta分析。结果纳入7个RCT,合计367例患者。Meta分析结果显示,PBSC经冠状动脉移植与常规治疗比较能提高心肌梗死患者的左心室射血分数(LVEF)(MD=3.91%,95%CI=2.30~5.52,P<0.00001),降低左心室收缩末容积(LVESV)[MD=-7.57ml,95%CI=-12.65^-2.49,P=0.003),但对左心室舒张末容积(LVEDV)无影响(MD=-7.14ml,95%CI=-14.43~0.14,P=0.05)。亚组分析显示,对急性心肌梗死和慢性心肌梗死患者,PBSC移植均能提高其LVEF,降低LVESV,但对LVEDV无影响;移植细胞数<108个能提高心肌梗死患者LVEF,降低LVESV,但对LVEDV无影响,移植细胞数>108个能提高心肌梗死患者LVEF,但对LVESV和LVEDV无影响。结论 PBSC经冠状动脉移植可以改善心肌梗死患者的心功能,较少的细胞移植数(<108个)可能对心肌梗死患者更有益。其不良反应主要集中在干细胞动员阶段,但远期并发症还需今后更多高质量研究证实。

Objective To evaluate the efficacy and safety of autologous transplantation of peripheral blood stem cells（PBSC）for myocardial infarction（MI）.Methods Relevant randomized clinical trials（RCTs）reported on PubMed （from Jan.1 966 to June 2013）,EMbase （from Jan.1974 to June 2013）,ISI Web of Knowledge （from Jan.1 945 to June 2013）,Cochrane Library （Issue 6,2013）,CBM （from Jan.1978 to June 2013）,VIP （from Jan.1 989 to June 2013）,CNKI （from Jan.1 91 5 to June 2013）and WanFang Database （from Jan.1 996 to June 2013）were searched by two reviewers according to the inclusion criteria.Then,the methodological quality of the included studies were evaluated by modified Jadad Scale and the data were analyzed by RevMan 5.2.Results Seven studies including 367 patients were identified.The results of the meta-analysis showed that autologous transplantation of PBSCs could improve the left ventricular ejection fraction（LVEF）（MD = 3.91%,95% CI = 2.30%-5.52%,P 〈 0.00001 ）and reduce the left ventricular end-systolic volume（LVESV）（MD =-7.57 ml,95% CI =-12.65--2.49,P =0.003）, but had no effect on the left ventricular end-diastolic volume（LVEDV）（MD = -7.14 ml,95% CI = -14.43-0.14 ml,P =0.05）,as compared with the control group.Subgroup analysis revealed that autologous transplantation of PBSCs improved LVEF and reduced LVESV in both acute and chronic MI.Low dose of stem cells improved LVEF and reduced LVESV,but high dose of PBSCs could only improve LVEF.Conclusion The current evidences show that autologous transplantation of PBSCs can improve the left ventricular function for MI patients and low dose of stem cells may have better effects.Future studies should focus on the long term efficacy and safety of autologous transplantation of PBSCs for MI.