骨髓单个核细胞移植对心肌梗死后心功能影响的Meta分析  

Influence of bone marrow mononuclear stem cells transplantation on heart function after myocardial infarction: a Meta-analysis

作　　者：曹腾[1,2] 王家宁[2] 唐俊明[2] 张蕾[2] 李小玲[2] 杨建业[2] 郑飞[2] 王露[2] 

机构地区：[1]武汉大学人民医院,武汉430060 [2]湖北十堰湖北医药学院附属人民医院临床医学研究所

出　　处：《中国循证心血管医学杂志》2014年第4期390-395,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨骨髓单个核细胞(BMMSC)移植治疗心肌梗死的疗效。方法应用计算机从PubMed、Cochrane、中国期刊全文数据库、万方数据库、维普资讯等电子数据库中检索2014年8月以前有关自体骨髓单个核细胞移植治疗心肌梗死的随机对照试验。通过提取数据进行Meta分析探讨骨髓单个核细胞移植对心肌梗死后心功能的影响。结果对纳入的12个随机对照试验进行Meta分析,随访至少3个月后各项指标与基础值比较,植入BMMSC后左室射血分数(LVEF)明显增加(WMD=3.65%,95%CI:3.35%~3.95%,P<0.00001),但存在明显异质性(I2=86%,P<0.00001);进行亚组分析:基础LVEF<40%亚组BMMSC治疗组LVEF水平较对照组增加,差异有统计学意义(WMD=4.06%,95%CI:3.74%~4.37%,P<0.00001);基础LVEF>40%亚组BMMSC治疗组LVEF水平与对照组相比,差异无统计学意义(WMD=-0.89%,95%CI:-1.94%~0.15%,P>0.05)。BMMSC治疗组较对照组左室收缩期末容积较前下降,且有统计学差异(WMD=-6.28%,95%CI:-8.39%^-4.16%,P<0.00001)。BMMSC治疗组左室舒张期末容积与对照组相比,无统计学差异且存在明显异质性(P=0.0005,I2=70%);进行亚组分析:基础LVEF<40%亚组仍无法消除异质性(P<0.00001,I2=89%),排除左室舒张期末容积较其他研究明显增大的研究后,异质性消除且差异具有统计学意义(WMD=-4.29%,95%CI:-8.14%^-0.45%,P<0.05);基础LVEF>40%亚组BMMSC治疗组与对照组相比差异无统计学意义(WMD=-1.41%,95%CI:-6.04%~3.22%,P>0.05)。结论自体骨髓单个核细胞移植能够提高心肌梗死后左室收缩功能,抑制心室重塑,对基础LVEF<40%患者效果明显。Objective To discuss the curative effect of bone marrow mononuclear stem cells （BMMSC） transplantation on myocardial infarction （MI）. Methods The databases of PubMed, Cochrane, CNKI, WangFang Database and VIP Database were retrieved by using computer for collecting the randomized controlled trials （RCT） about the treatment of MI with BMMSC transplantation. The influence of BMMSC transplantation on heart function after MI was studied through a Meta-analysis on extracted data. Results A Meta-analysis was conducted in included 12 RCT and after followed up for 3 m, the comparison in all indexes and base values showed that LVEF increased significantly （WMD=3.65%, 95%CI：3.35%-3.95%, P〈0.00001） but there was significant heterogeneity （I2=86%, P〈0.00001） after BMMSC transplantation. The analysis in subgroups showed that in subgroup 1 （basic LVEF〈40%） LVEF increased than that in control group （WMD=4.06%, 95%CI：3.74%-4.37%, P〈0.00001）, and in subgroup 2 （basic LVEF〈40%） LVEF had no statistical difference compared with control group （WMD=-0.89%, 95%CI：-1.94%-0.15%, P〉0.05）. LVESV decreased in BMMSC group compared with control group （WMD=-6.28%, 95%CI： -8.39%--4.16%, P〈0.00001）. LVEDV had no statistical difference but had significant heterogeneity between BMMSC group and control group （P=0.0005, I^2=70%）. The analysis in subgroups showed that in subgroup 1, heterogeneity could not be removed （P〈0.00001, I^2=89%）, and after excluding the trials with higher LVEDV, heterogeneity was removed and difference had statistical significance （WMD=-4.29%, 95%CI：-8.14%--0.45%, P〈0.05）, while in subgroup 2, the difference had no statistical significance compared with control group （WMD=-1.41%, 95%CI：-6.04%-3.22%, P〉0.05）. Conclusion BMMSC transplantation can improve left ventricular systolic function and inhibit ventricular remodeling after MI. It has significant efficacy in patients with basic LVEF〈40%.

关 键 词：骨髓单个核细胞 细胞移植 心肌梗死 心功能 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]