自体骨髓单个核细胞移植治疗扩张性心肌病有效性的Meta分析

The Effectiveness of Autologous Bone Marrow Mononuclear Cells Transplantation for Dilated Cardiomyopathy: A Meta-analysis

目的:运用Meta分析的方法评价骨髓单个核细胞(MNCs)移植治疗扩张性心肌病(DCM)的有效性。方法:检索Pub Med、Embase、Cochrane Library、CNKI、CBM、VIP、Wan-Fang数据库中自体MNCs移植与常规药物比较治疗DCM有效性的临床随机对照试验(RCT)。两名研究者独立按纳入排除标准筛选文献、提取数据、并行文献质量评价。运用R3.1.0软件进行统计分析。结果:纳入7个RCT,合计DCM患者344例。Meta分析显示MNCs移植与常规药物比较,在增加左室射血分数、减小左室舒张末期内径上差异有统计学意义(射血分数:MD=3.23,95%CI=1.55~4.91;舒张末期内径:MD=-1.64,95%CI=-2.59^-0.69),但在降低患者病死率上差异无统计学意义(RR=0.89,95%CI=0.57~1.39)。结论:当前证据显示MNCs移植治疗DCM优于常规药物,但MNCs移植不能更有效地降低DCM病死率。基于现有研究缺陷,本研究结论需大量高质量、长期随访的RCT予以证实。

Objective To evaluate the effectiveness of autologous bone marrow mononuclear cells（ MNCs） transplantation for patients with dilated cardiomyopathy（ DCM） by Meta analysis.Methods We systematically searched the Pub Med,Cochrane Library,Embase,CNKI,CBM,VIP,Wan-Fang databases for randomized clinical controlled trials（ RCTs） about MNCs and conventional drugs for DCM.Two reviewers independently identified literatures according to inclusion and exclusion criteria,extracted information,and evaluated the eligible studies＇ s quality.Then meta-analysis was performed by using R3.1.0 software. Results Finally,7 RCTs involving 344 patients were included. The results of meta-analysis showed that there were significant difference between the MNCs transplantation and conventional drugs group in increasing the left ventricular ejection fraction（ MD = 3. 23,95% CI = 1. 55 ～ 4. 91）,and decreasing the left ventricular end-diastolic diameter（ MD =-1. 64,95%CI =-2.59 ～-0.69）.But there was no difference in reducing the mortality（ RR = 0.89,95% CI = 0.57 ～ 1.39）. Conclusion Current evidence shows that autologous MNCs transplantation is superior to conventional drugs for DCM. But MNCs does not appeare a greater advantage in reducing the mortality.Due to the limited quantity and quality of the included studies,more high-quality and long-term RCTs are need to verify the above conclusion.