干细胞移植治疗改善扩心病心功能的Meta分析

Improvement of cardial function of stem cell transplantation in dilated cardiomyopathy: A Meta-analysis

目的系统评价干细胞移植治疗对扩张型心肌病心功能的改善情况。方法计算机检索Pubmed、EMbase、Cochrane图书馆、中国知网、万方数据库、维普数据库,查找所有骨髓干细胞治疗扩张型心肌病的随机对照试验(RCT),检索时间为建库至2016年5月31日。由两名研究者按照纳入与排除标准筛选文献、提取资料、评价纳入研究的质量后,用Revman5.3及stata12.0软件进行meta分析。结果共纳入15篇RCT,包括714例患者,Meta分析结果显示:1移植组与对照组死亡人数无统计学差异(OR=0.66,95%CI:0.33~1.29,P=0.22);2术后移植组3个月时左室射血分数(LVEF)增加与对照组差异无统计学意义(SMD=0.42,95%CI:-0.06~0.90,P=0.08),6个月时LVEF增加较对照组明显,差异有统计学意义(SMD=0.56,95%CI:0.06~1.05,P=0.03);3术后1个月移植组与对照组左室舒张末径(LVEDd)差异无统计学意义(SMD=-0.65,95%CI:-1.96~0.67,P=0.34),术后3个月移植组LVEDd较对照组小,差异有统计学差异(SMD=-1.59,95%CI:-2.75^-0.43,P=0.007);4亚组分析显示移植干细胞剂量<108时,对LVEF(SMD=1.16,95%CI:-6.05~8.37,P=0.75)和LVEDd(SMD=0.23,95%CI:-2.73~3.18,P=0.88)的影响与对照组无差异,两组死亡率无统计学差异(SMD=0.35,95%CI:0.05~2.65,P=0.31);移植干细胞剂量>108时,可提高患者LVEF(SMD=4.37,95%CI:2.30~6.45,P<0.00001),减小LVEDd(SMD=-2.25,95%CI:-3.63~0.86,P=0.001),两组死亡率无统计学差异(OR=0.73,95%CI:0.38~1.43,P=0.36)。结论干细胞移植可改善扩张型心肌病患者心功能及改善其左室重构,且这一作用在远期时更明显;移植干细胞数量较大(>108)可能更有益。

Objective To systematical evaluate the improvement of cardiac function by stem celltransplantation in dilated cardiomyopathy.Methods Randomized controlled trials(RCTs)of all the bone marrowstem cells in the treatment of dilated cardiomyopathy were searched within PubMed,EMBASE,the CochraneLibrary,CNKI,Wanfang Database and VIP Database.The retrieval time was from May31,2016.The quality of theincluded studies was evaluated by two investigators based on the inclusion and exclusion criteria.Meta-analysiswas performed using Revman5.3and stata12.0software.Results A total of15trials involving714patients wereincluded.The result of Meta-analysis showed that①There was no difference between transplant group and controlgroup in overall mortality(OR=0.66,95%CI:0.33~1.29,P=0.22).②There was no difference between two groupsin improvement of left ventricular ejection fraction(LVEF)at3months after treatment(SMD=0.42,95%CI:-0.06~0.90,P=0.08),but the LVEF was increased at6months after treatment(SMD=0.56,95%CI:0.06~1.05,P=0.03).③There was no difference between two groups in reduce of left ventricular end-diastolic diameter(LVEDd)at1month after treatment(SMD=-0.65,95%CI:-1.96~0.67,P=0.34),but LVEDd was decreased at3months aftertreatment in transplant group than that in control group(SMD=-1.59,95%CI:-2.75^-0.43,P=0.007).④Result ofsubgroup analysis showed no difference with respect to LVEF(SMD=1.16,95%CI:-6.05~8.37,P=0.75),LVEDd(SMD=0.23,95%CI:-2.73~3.18,P=0.88)and overall mortality(OR=0.35,95%CI:0.05~2.65,P=0.31)when thenumber of transplant cells<108.But when the number of transplant cells>108,LVEF was improved(SMD=4.37,95%CI:2.30~6.45,P<0.00001),and LVEDd was reduced(SMD=-2.25,95%CI=-3.63~0.86,P=0.001)significantly.There was no difference between two groups in overall mortality(OR=0.73,95%CI:0.38~1.43P=0.36).Conclusion Stem cell transplant can improve cardiac function and reconstruct cardiac muscular structure,which are more obvious in long-term observation.Transplant cell>108may be more beneficial.