间充质干细胞治疗缺血性脑卒中安全性与疗效的Meta分析

目的:通过系统评价明确间充质干细胞治疗缺血性脑卒中的安全性与疗效,并提供相关循证医学证据。方法:计算机检索中文数据库(中国知网、万方、维普)以及英文数据库(PubMed、The Cochrane Library、Embase)有关间充质干细胞治疗脑卒中的临床对照试验,检索时间限定到2021-09-30,以美国国立卫生研究院卒中量表评分、日常生活能力指数、运动功能评分、功能独立性评分、改良Rankin评分为结局指标,由2名研究员独立进行文献筛选、数据提取及研究质量评估,其中随机对照试验采用“Cochrane偏倚风险评估工具”评估质量,并使用stata 15.0进行Meta分析、敏感性分析以及森林图的制作等。结果:纳入20个随机对照试验,共1127例缺血性脑卒中患者,文献总体质量较高。Meta分析结果显示:治疗3个月时,间充质干细胞组美国国立卫生研究院卒中量表评分、运动功能评分、功能独立性评分优于对照组WMD=-2.12(95%CI:-2.66至-1.58,Z=7.70,P<0.001),WMD=14.34(95%CI:12.99-15.68,Z=20.90,P<0.001),WMD=20.94(95%CI:9.28-22.59,Z=5.88,P<0.001)]。而日常生活能力指数、改良Rankin评分两组效果接近WMD=6.98(95%CI:-2.89-16.85,Z=1.39,P=0.166),WMD=-0.04(95%CI:-0.16-0.24,Z=0.44,P=0.663)]。其他各时点,除改良Rankin评分外,美国国立卫生研究院卒中量表评分、日常生活能力指数、运动功能评分、功能独立性情况评分均有显著改善。结论:间充质干细胞移植能在一定程度上改善缺血性脑卒中患者的神经功能缺损、运动功能、日常生活能力。

Safety and efficacy of mesenchymal stem cells in the treatment of ischemic stroke:a meta-analysis

OBJECTIVE: To systematically evaluate the safety and efficacy of mesenchymal stem cells in the treatment of ischemic stroke, and to provide relevant evidencebased medicine evidence. METHODS: Clinical controlled trials of mesenchymal stem cells in the treatment of stroke were searched from Chinese databases (CNKI, Wanfang, and VIP) and English databases (PubMed, The Cochrane Library, and Embase) for articles published until September 30, 2021. The United States National Institutes of Health Stroke Scale score, Barthel index, Fugl-Myer movement assessment score, functional independence measure score, and Modified Rankin Scale score were used as outcome measures. Literature screening, data extraction and research quality assessment were conducted independently by two researchers. The qualities of randomized controlled trials were assessed using Cochrane bias risk assessment tool. Stata 15.0 was used for meta-analysis, sensitivity analysis and forest plot making. RESULTS: A total of 1 127 patients with ischemic stroke were included from 20 randomized controlled trials. The overall quality of the literature was high. Metaanalysis results showed that the scores of National Institutes of Health Stroke Scale, Fugl-Myer movement assessment and functional independence measure score in the mesenchymal stem cell group were better than those in the control group after 3 months of treatment WMD=-2.12(95%CI:-2.66 to -1.58, Z=7.70, P < 0.001), WMD=14.34(95%CI:12.99-15.68, Z=20.90, P < 0.001), WMD=20.94(95%CI:9.28-22.59, Z=5.88, P < 0.001)]. Barthel index and Modified Rankin Scale score were similar between the two groups WMD=6.98(95%CI:-2.89-16.85, Z=1.39, P=0.166), WMD=-0.04(95%CI:-0.16 to 0.24, Z=0.44, P=0.663)]. Except for Modified Rankin Scale score, the scores of National Institutes of Health Stroke Scale, Barthel index, Fugl-Myer movement assessment and functional independence measure score were significantly improved at all other time points. CONCLUSION: Mesenchymal stem cell transplantation can improve the neurological deficit, motor function and daily living ability of patients with ischemic stroke. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.