关节内注射间充质干细胞对膝骨关节炎的疗效及软骨修复能力的Meta分析  

Clinical efficacy and cartilage repair effect of mesenchymal stem cells intra-articular injection for knee osteoarthritis:a meta-analysis of randomized control trials

作　　者：王睿 赵丽珂[1] 黄慈波[1] Wang Rui;Zhao Like;Huang Cibo(Department of Rheumatology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]北京医院国家老年医学中心风湿免疫科,100730

出　　处：《中华风湿病学杂志》2019年第12期803-809,共7页Chinese Journal of Rheumatology

摘　　要：目的系统评价关节内注射MSCs治疗膝骨关节炎(KOA)的疗效及软骨修复能力。方法系统检索Cochrane图书馆、PubMed、Embase(通过Ovid平台)、中国知网、万方数据库等数据库自建库至2019年3月关节内注射MSCs进行KOA治疗的临床随机对照试验(RCT)。按照入选和排除标准独立进行文献筛选与数据提取,采用Cochrane Handbook 5.1.0版本的"偏倚风险评估工具"对纳入研究的方法学进行评估,使用RevMan 5.3软件进行Meta分析。使用I2进行异质性检验,统计学分析采用随机效应模型,在倒方差加权法基础上,采用Dersimonian&Laird法,引入校正因子对权重进行校正后再计算合并效应量及其95%置信区间(CI)。结果Meta分析纳入了15项符合条件的临床试验,共576例患者。结果表明,相比于对照组,MSCs治疗组的VAS评分[MD=-15.51,95%CI(-24.29,-6.74),P=0.0005]、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分[MD=-11.08,95%CI(-16.78,-5.38),P=0.0001]和Lequesne指数[MD=-8.45,95%CI(-15.11,-1.80),P=0.01]显著降低,Lysholm膝关节评分和MRI评价结果的改善差异均无统计学意义(P>0.05)。结论关节内注射MSCs对KOA患者的疼痛控制和功能改善具有良好的疗效和安全性,但目前的研究对MSCs修复受损的软骨证据不足。Objective To assess the clinical efficacy and cartilage repair effect of mesenchymal stem cells(MSCs)intra-articular injection for knee osteoarthritis(KOA).Methods The databases,including Cochrane library,PubMed,Embase(via Ovid),CNKI and Wanfang,were searched from inception to March 2019.The clinical randomized controlled trials(RCTs)of MSC-based therapy in KOA were conducted.Two independent reviewers selected the studies and extracted information according to the inclusion and exclusion criteria.The quality was assessed by Cochrane Handbook's risk of bias tool.The Meta-analysis was conducted by Revman 5.3 software.I2 was used for heterogeneity test,and random effects model was used for statistical analysis.Based on the inverse-variance method,the Dersimonian&Laird method was used to introduce correction factors to correct the weights and then calculate the combined effect amount and its 95%confidence interval(CI).Results Fifteen eligible clinical trials were included in this Meta-analysis,with a total of 576 patients.Compared with the control group,our study showed that the Visual analogue score(VAS)[MD=-15.51,95%CI(-24.29,-6.74),P=0.0005],Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score[MD=-11.08,95%CI(-16.78,-5.38),P=0.0001],and Lequesne index[MD=-8.45,95%CI(-15.11,-1.80),P=0.01]were significantly decreased in the MSCs treatment group.However,there was no statistical significance in Lysholm knee score and MRI evaluation results(P>0.05).Conclusion This Meta-analysis has demonstrated that intra-articular injection of MSCs has good efficacy and safety in pain control and functional improvement in patients with KOA.But the results of the study do not show evidence of MSCs in repairing damaged cartilage.

关 键 词：骨关节炎 干细胞 软骨 META分析 

分 类 号：R6[医药卫生—外科学]