间充质干细胞治疗缺血性脑卒中的荟萃分析

Effect of Mesenchymal Stem Cells Treatment on Ischemic Stroke:a Meta-analysis

目的:收集间充质干细胞治疗缺血性脑卒中的临床对照研究,并对其疗效进行系统评价。方法:计算机检索Pub Med、Embase、Cochrane library、中国知网(CNKI)、万方数据知识服务平台、中文科技期刊数据库(维普期刊)等数据库。筛选纳入间充质干细胞治疗缺血性脑卒中的临床对照研究进行荟萃分析。结果:最终纳入文献13篇,共计患者686例。Meta分析结果显示,美国国立卫生院卒中量表结果中,间充质干细胞优于常规治疗[SMD=-1.022,95%CI(-1.312,-0.732),P=0.000];Fugl-Meyer量表结果中,间充质干细胞同样优于常规治疗[SMD=1.009,95%CI(0.107,1.911),P=0.028]。而巴氏指数、改良Rankin量表评分及功能独立性评分结果中,间充质干细胞未显示出治疗优势。亚组分析及Meta回归分析显示,是否通过静脉输注以及输注细胞数量可能是造成结果异质性的原因。结论:间充质干细胞对缺血性脑卒中患者的神经功能恢复具有一定的治疗作用,但是对于患者的日常生活能力恢复效果有限。此外,不同的细胞输注途径、不同的细胞注射剂量以及选用的细胞类型可能会造成结果的差异。

Objective：To collect and analyze the clinical controlled studies on ischemic stroke treated with mesenchymal stem cells and to evaluate the therapeutic effect. Methods： We searched the database including PubMed, Embase, Cochrane library, CNKI, Wanfang data, Cqvip et al. The controlled clinical trials for ischemic stroke treated with mesenchymal stem cells were included into meta-analysis. Results： Total 13 trials and 686 patients were eventually included in the analysis. The mesenchymal stem cell treatment showed a better therapeutic effect evaluated by National Institute of Health Stroke Scale [SMD=-1.022, 95% CI（-1.312, --0.732）, P=-0.000] and Fugl-Meyer Scale [SMD=1.009, 95%CI（0.107, 1.911）, P=-0.028] assessment. But compared with conventional therapy, mesenchymal stem cells did not show advantages on Barthel index, modified Rankin Scale and Functional independence measure assessment. Subgroup analysis and meta-regression showed that the transplant routes and the doses of injected cells may cause the heterogeneity of results. Conclusion： Mesenchymal stem ceils treatment has a significant therapeutic effect on the recovery of neurological function of ischemic stroke with limited effect on the improvement of daily life. In addition, the transplant routes, doses of injected cells and cell types may cause the differences of the results.