骨髓干细胞移植治疗扩张性心肌病疗效及安全性的系统评价  

Efficacy and Safety of Bone Marrow Stem Cells Transplantation for Dilated Cardiomyopathy:A Systematic Review

作　　者：杨柳[1] 唐其柱[2] 郭毅[3] 

机构地区：[1]武汉大学校医院内科,武汉430072 [2]武汉大学人民医院心血管内科,武汉430060 [3]武汉大学公共卫生学院流行病学教研室,武汉430071

出　　处：《中国循证医学杂志》2015年第2期194-200,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价骨髓干细胞移植治疗原发性扩张型心肌病的临床疗效和安全性。方法计算机检索Pub Med、CENTRAL、EMbase、Web of Knowledge、VIP、CNKI、CBM和Wan Fang Data数据库,查找所有骨髓干细胞移植治疗扩张性心肌病的随机对照试验(RCT),检索时限均为建库至2014年3月31日。由2位研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量,而后采用Rev Man 5.2.0软件进行Meta分析。结果共纳入10个RCT,包括374例患者。Meta分析结果显示:1安全性:与常规治疗相比,骨髓干细胞移植3个月后患者恶性心律失常事件发生率差异无统计学意义[RR=0.81,95%CI(0.38,1.72),P=0.58]。2疗效:与对照组相比,骨髓干细胞移植3个月后患者左室射血分数增加[WMD=3.86,95%CI(2.53,5.20),P<0.000 01]、6个月后左室射血分数增加[WMD=5.54,95%CI(3.02,8.06),P<0.000 1],3个月后6 min步行距离增加[WMD=22.12,95%CI(7.78,36.46),P=0.003],6个月后6 min步行距离增加[WMD=102.79,95%CI(50.16,155.41),P=0.000 1],3个月的心肌灌注缺损面积百分比减小[WMD=–4.00,95%CI(–5.87,–2.13),P<0.000 1];但在3个月后左室舒张末期内径[WMD=–0.37,95%CI(–1.67,0.93),P=0.57]和6个月后左室舒张末期内径[WMD=–0.70,95%CI(–2.76,1.36),P=0.51]方面,差异无统计学意义。结论骨髓干细胞移植治疗扩张性心肌病可明显改善患者心功能且安全性较好。受纳入研究数量和质量的限制,上述结果仍需要更多高质量、大样本的RCT予以验证。Objective To systematically review clinical efficacy and safety of bone marrow stem cells transplantation in treating primary dilated cardiomyopathy （DCM）. Methods Such databases as PubMed, CENTRAL, EMbase, Web of Knowledge, VIP, CNKI, CBM and WanFang Data were searched from inception to March 2014 for the randomized controlled trials （RCTs） about bone marrow stem cells transplantation for DCM. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2.0 software. Results A total of ten RCTs involving 374 patients were included. The results of meta-analysis showed that, a） for safety, after 3 months there was no significant difference in the incidence of malignant arrhythmia events between bone marrow stem cell transplantation group and routine treatment group （RR =0.81, 95%CI 0.38 to 1.72, P=0.58）; and b） for efficacy, compared with the control group, left ventricular ejection fraction （LVEF） increased in the bone marrow stem cell transplantation group after 3 months （WMD=3.86, 95% CI 2.53 to 5.20, P〈0.000 01） and after 6 months （WMD=5.54, 95%CI 3.02 to 8.06, P〈0.0001）. The bone marrow stem cell transplantation group were better in increased 6-minute walking distance after 3 months （WMD=22.12, 95%CI 7.78 to 36.46, P=0.003）, increased 6-minute walking distance after 6 months （WMD= 102.79, 95%CI 50.16 to 155.41, P=0.000 1）, decreased perfusion defect of myocardium percentage after 3 months （WMD= -4.00, 95%CI -5.87 to -2.13, P〈0.000 1）. However, there was no significant difference in left ventricular end-diastolic diameter（LVEDD） between two groups after 3 months （WMD= -0.37, 95%CI -1.67 to 0.93, P=0.57） and after 6 months （WMD= -0.70, 95%CI -2.76 to 1.36, P=0.51）. Conclusion Bone marrow stern cells transplantation for dilated cardiomyopathy is effective in improve patients＇ heart function with

关 键 词：骨髓干细胞移植 扩张型心肌病 META分析 系统评价 随机对照试验 

分 类 号：R542.2[医药卫生—心血管疾病]