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1. 南华大学附属南华医院消化内科,衡阳,421000
2. 南华大学附属第一医院心内科,衡阳,421000
3. 中山大学肿瘤防治中心,广州,510000
纸质出版日期:2018,
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张小燕, 李志艳, 颜波, 等. 自体骨髓间充质干细胞移植治疗失代偿期肝硬化Meta分析[J]. 重庆医科大学学报, 2018,43(1):81.
Zhang Xiaoyan, Li Zhiyan, Yan Bo, et al. Autologous mesenchymal stem cell transplantation for end-stage liver cirrhosis:a Meta-analysis[J]. Journal of Chongqing Medical University, 2018,43(1):81.
目的:旨在汇集以前的临床对照实验,对BM-MSCs移植治疗晚期肝硬化进行有效性评估。方法:利用计算机联合检索万方(1990年1月至2016年5月)、知网(1990年1月至2016年5月)、PubMed(1990年1月至2016年5月)、Embase (1990年1月至2016年5月)、The Cochrane Library(2016年5期)、Science direct(1990年1月至2016年5月)、Medline(1990年1月至2016年5月)等数据库关于BM-MSCs移植治疗失代偿期肝硬化的随机对照试验(randomized controlled trial,RCT)文献。语种限中文或英文,根据纳入和剔除标准筛选出符合要求的文献。以终末期肝脏疾病(end-stage liver disease,MELD)评分、凝血酶原时间国际标准化比值(international normalized ratio,INR)、谷草转氨酶(aspertate aminotransferase,AST)等作为文章主要分析指标,用Review Manager 5.3软件进行Meta分析。结果:纳入文献8 篇,共507例肝硬化患者(255例对照组,252例BM-MSCs治疗组)。与对照组相比,BM-MSCs治疗1个月后MELD评分(MD=-1.65,95%CI=-2.8~-0.50,P=0.005),AST(MD=-0.26,95%CI=-0.44~-0.08,P=0.005),INR(MD=-0.26,95%CI=-0.44~-0.08,P=0.005)明显下降;BM-MSCs治疗6个月后疗效优于对照组:MELD评分(MD=-1.65,95%CI=-2.80~-0.50,P=0.005),AST(MD=-0.26,95%CI=-0.44~-0.08,P=0.005),INR(MD=-0.26,95%CI=-0.44~-0.08,P=0.005)。结论:由于BM-MSCs具有调节免疫及分化成肝细胞的潜能,因此它可作为一种有前途的肝硬化治疗剂。且目前研究发现这种疗法能比较安全及有效地改善肝功能。然而,不同的变量在肝硬化优化治疗中如何控制尚不清楚。因此,肝硬化优化治疗策略需要在未来的临床试验及机制研究中进一步探讨。
Objective:To effective evaluate the previous controlled clinical trials of bone marrow mesenchymal stem cells(BM-MSCs) transplantation for end-stage liver cirrhosis validity assessment. Methods:Wanfang database(1990.01-2016.05),CNKI(1990.01-2016.05),PubMed(1990.01-2016.05),Embase(1990.01-2016.05),The Cochrane Library(Issue 5,2016),Science direct(1990.01-2016.05),Medline(1990.01-2016.05) were retrieved for publication in all languages and relevant literature and experiments designed for randomized controlled trial(RCT). All enrolled publication met the requirements according to the inclusion and exclusion criteria. Meta-analysis was performed by using Review Manager 5.3 software and end-stage liver disease(MELD) score,prothrombin time in-ternational normalized ratio(INR),aspertate aminotransferase(AST) were taken as the main analyzing indicators. Results:Eight refer-ences were enrolled including a total of 507 patients with liver cirrhosis(255 cases of control group,252 cases of BM-MSCs treatment group). Compared with those of control group,BM-MSCs trans-plantation in patients with decompensated cirrhosis MELD score(MD=1.65,95%CI=2.8 to 0.50,P=0.005),AST(MD=0.26,95%CI=0.44 to 0.08,P=0.005),INR(MD=0.26,95%CI=0.44 to 0.08,P=0.005) significantly decreased after 1 month;BM-MSCs treatment effect were superior to that of control group after six months:MELD score(MD=1.65,95%CI=2.80 to 0.50,P=0.005),AST(MD=0.26,95%CI=0.44 to 0.08,P=0.005),INR(MD=0.26,95%CI=0.44 to 0.08,P=0.005). Conclusion:Due to the potential of the immune regulation of BM-MSCs and its differentiation into liver cells,BM-MSCs can be used as a promising thera-peutic agent for liver cirrhosis. And the current study found that this therapy can be safe and effective in improving liver function. However,how to control different variables to optimize the treatment of cirrhosis of the liver is not clear,therefore,cirrhosis optimize treatment strategies need to be further explored in future clinical trials and research mechanisms.
失代偿期肝硬化骨髓间充质干细胞移植Meta分析
decompensated cirrhosis of the livermarrow-derived mesenchymalstem cellstransplantationMeta-analysis
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