间充质干细胞对移植物抗宿主病预防作用的Meta分析

Role of Mesenchymal Stem Cells in Preventing GVHD:A Meta-Analysis

目的:评价间充质干细胞(MSC)在造血干细胞移植(HSCT)后对移植物抗宿主病(GVHD)预防作用的疗效。方法:检索Pub Med数据库(1950年1月-2014年3月)、EMbase数据库(1970年1月-2014年3月)、Cochrane图书馆临床对照试验数据库(CENTRAL,2014年第4期)、中国生物医学文献数据库(CBM,1978年1月-2014年3月);对纳入文献的参考文献进一步扩大检索。所纳入随机对照试验(RCT)依据Cochrane风险偏倚评价工具进行质量评价。采用Rev Man 5.1软件进行统计分析,评价MSC对GVHD预防作用的疗效。结果:共纳入3篇英文文献,纳入HSCT患者117例,其中MSC组56例,对照组61例。Meta分析结果显示:MSC未能降低急、慢性GVHD发生率(RR:0.44,95%CI:0.08-2.51,P=0.35;RR:0.85,95%CI:0.54-1.33,P=0.47);MSC未增加原发病复发率及巨细胞病毒感染率(RR:1.52,95%CI:0.63-3.68,P=0.35;RR:1.05,95%CI:0.72-1.53,P=0.78);M SC未改善病人总体生存率(RR:1.06,95%CI:0.79-1.43,P=0.71)。结论:M SC可能对GVHD有一定预防作用,但由于尚缺乏大样本的RCT证据支持,MSC对GVHD的预防作用尚不能作出最后结论,需更多大样本、高质量的RCT研究才能得出肯定性结论。

Objective : To evaluate the efficacy of mesenchymal stem cells( M SC) in the prevention of graft versus host disease( GVHD) after hematopoietic stem cell transplantation( HSCT). Me thods: Randomized controlled trials( RCT) were identified from Pub Med( 1950. 1-2014. 3),EMbase( 1970. 1-2014. 3),Cochrane Central Register of Controlled Trials( CENTRAL,issue 4,2014) of the Cochrane Library,China Biological M edicine( CBM,1978. 1-2014. 3). References of retrieved articles were also identified. The quality of each RCT was evaluated by the Cochrane collaboration’s tool for assessing the risk of bias. Data analysis was performed with ReviewM anager 5. 1 to evaluate the efficacy of M SC in the prevention of GVHD after HSCT. Re sults: A total of 3 English articles involving 117 patients were included. M eta-analysis indicated that M SC did not reduce the incidence of acute GVHD and chronic GVHD( RR: 0. 44,95% CI: 0. 08 to 2. 51,P = 0. 35; RR: 0. 85,95% CI: 0. 54 to 1. 33,P = 0. 47). However,MSC did not increase occurrence of relapse and cytomegalovirus infection( RR: 1. 52,95% CI: 0. 63 to 3. 68,P = 0. 35; RR: 1. 05,95% CI: 0. 72 to 1. 53,P = 0. 78). Finally,M SC did not improve overall survival rate of patients received HSCT( RR:1. 06,95% CI: 0. 79 to 1. 43,P = 0. 71). Conclusion: M SC may have a preventive effect on GVHD in patients undergoing HSCT. However,the evidence is weak due to the small sample sizes. Thus,a reliable conclusion about the preventive effect of M SC on GVHD at the moment has not been made,further larger,high quality,randomized and controlled trials are warranted.