间充质干细胞移植治疗脊髓损伤:系统评价及Meta分析

Mesenchymal stem cell transplantation for spinal cord injury: a Meta-analysis

背景:近年来,已在动物模型上验证了干细胞移植治疗脊髓损伤的有效性,其中间充质干细胞治疗脊髓损伤的研究最为广泛,目前也开展了一些临床研究,显示出良好的应用前景。目的:系统评价间充质干细胞移植治疗人脊髓损伤的安全性和有效性。方法:计算机检索Pub Med、EMBASE、Cochrane Library、ISI Web of knowledge、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)及万方数据库中间充质干细胞移植治疗人脊髓损伤的随机对照试验,检索时间均从建库至2015年7月。中文检索词为"脊髓损伤、截瘫、间充质干细胞、细胞移植、移植、骨髓移植、随机对照试验";英文检索词为"spinal cord injury、paraplegia、cell transplantation、transplantation、mesenchymal stem cell、bone marrow transplantaion、stem cell、Randomized controlled trial"。结果与结论:共计检索到260篇文献,其中6篇为随机对照试验,合计252例脊髓损伤患者。与对照组相比间充质干细胞移植能提高脊髓损伤患者的ASIA触觉评分、Frankel评分总体改善率、日常生活能力训练评分,差异有显著性意义(P<0.05),也能提高患者的ASIA运动评分、减少膀胱残余尿量,但差异无显著性意义(P>0.05)。与对照组相比间充质干细胞移植有更高的低热反应,差异有显著性意义(P<0.05),此外,进行蛛网膜下腔穿刺移植也可以引起双下肢麻木,但与对照组相比差异无显著性意义(P>0.05)。以上结果说明间充质干细胞移植治疗脊髓损伤有一定疗效,未发生严重并发症,但是还需要高质量的随机对照研究来证实间充质干细胞的安全性及有效性。

BACKGROUND： In recent years, the effectiveness of stem cell transplantation in the treatment of spinal cord injury has been validated in animal models, and mesenchymal stem cell transplantation for treatment of spinal cord injury has been studied most widely. Currently, there are a number of relevant clinical studies that have shown a good prospect. OBJECTIVE： To evaluate the efficacy and safety of mesenchymal stem cell transplantation for spinal cord injury in human with a system review. METHODS： Pub Med database, EMBASE database, Cochrane Library, ISI Web of knowledge, CBM database, VIP database, CNKI database and Wanfang database were searched from their start year up to July 2015 for relevant randomized clinical trials on the treatment of spinal cord injury with mesenchymal stem cell transplantation. The key words were ＂spinal cord injury, paraplegia, cell transplantation, transplantation,mesenchymal stem cell, bone marrow transplantation, stem cell, randomized controlled trial＂ in English and Chinese, respectively. RESULTS AND CONCLUSION： A total of 260 articles were retrieved, including 6 randomized clinical trials（252 cases）. In the aspects of ASIA touch sensation score, overall Frankel score and daily life activity training score, the patients undergoing mesenchymal stem cell transplantation were significantly superior to those in the control group（P〈0.05）. In addition, ASIA motor function score and residual urine volume were also improved in the patients undergoing mesenchymal stem cell transplantation, but there was no statistical difference（P〉0.05）. Compared with the control group, low fever was more common in the patients undergoing mesechymal stem cell transplantation（P〉0.05）. Another side effect was lower limb numbness, but there was no difference from the control group（P〈0.05）. These findings suggest that mesenchymal stem cell transplantation has limited efficacy in the treatment of spinal cord injury and cannot induce severe complications, but there is a need for high-quality randomized controlled trials to prove the efficiency and safety of mesenchymal stem cell transplantation for the treatment of spinal cord injury.