干细胞移植治疗扩张型心肌病疗效与安全性的Meta分析  

A Meta-analysis of the efficacy and safety of stem cell transplantation in patients with dilated cardiomyopathy

作　　者：朱琳[1] 明黎 童可 李秋姝 余更生[1] ZHU Lin;MING Li;TONG Ke;LI Qiushu;YU Gengsheng(Department of Cardiology,Children′s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Developmental Disorder,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院心内科、儿童发育疾病研究教育部重点实验室、国家儿童健康与疾病临床医学研究中心、儿童发育重大疾病国家国际科技合作基地、儿科学重庆市重点实验室,重庆400014

出　　处：《临床心血管病杂志》2021年第5期458-462,共5页Journal of Clinical Cardiology

摘　　要：目的:系统评价干细胞移植治疗扩张型心肌病的疗效与安全性。方法:对PubMed、Embase、Cochrane Library、Medline、Web of Science及知网、维普、万方、CBM于2020年10月1日前发表的随机对照试验进行系统检索。采用RevMan5.3及STATA15进行Meta分析。结局指标包括病死率及不良事件发生率、左心室射血分数(LVEF)、左心室舒张末期容积(LVEDCs)、左心室收缩末期容积(LVESCs)、六分钟步行距离(6MWD)、氨基末端脑钠尿肽前体(NT-proBNP)。结果:最终纳入9项随机对照试验,共包括607例患者。Meta分析结果表明,干细胞移植不会增加病死率(RR=0.72,95%CI:0.52~1.01,P=0.196)及不良事件发生率(RR=1.25,95%CI:0.68~2.27,P=0.617),并可提高LVEF(WMD=5.02,95%CI:3.32~6.73,P=0.005),降低LVEDCs(SMD=-0.82,95%CI:-1.42~-0.22,P=0)及NT-proBNP(WMD=-1534.00,95%CI:-2410.06~-657.95,P=0);但对LVESCs(SMD=0.12,95%CI:-0.78~1.01,P=0);和6MWD(WMD=51.39,95%CI:-11.65~114.43,P=0)无影响。结论:干细胞移植治疗扩张型心脏病不会增加病死率及不良事件发生率,对提高LVEF、降低LVEDCs及NT-proBNP有一定疗效,但对降低LVESCs和提高6MWD影响不大,未来还需更多大型随机对照试验来进一步明确干细胞治疗对扩张型心肌病患者的影响。Objective:To evaluate the efficacy and safety of stem cell transplantation in patients with dilated cardiomyopathy with meta-analysis.Methods:We searched the randomized controlled trials in PubMed,Embase,and Cochrane library,Medline,Web of Science and CNKI,VIP,WANFANG,CBM until October 2020.The inclusion trials were meta-analyzed by Revman 5.3 and STATA 15.The outcome indexes included mortality and adverse events,left ventricular ejection fraction(LVEF),left ventricular end diastolic chamber size(LVEDCs),left ventricular end systolic chamber size(LVESCs),6 minutes walking distanse(6 MWD)and NT-proBNP.Results:The 607 patients with dilated cardiomyopathy from 9 trials were involved.The results showed that stem cell therapy wouldn’t impove mortality(RR=0.72,95%CI:0.52-1.01,P=0.196)neither adverse events(RR=1.25,95%CI:0.68-2.27,P=0.617).It could ameliorate LVEF(WMD=5.02,95%CI:3.32-6.73,P=0.005),reduces LVEDCs(SMD=-0.82,95%CI:-1.42--0.22,P=0)and NT-proBNP(WMD=-1534.00,95%CI:-2410.06--657.95,P=0).However,stem cell therapy has no effect on LVESCs(SMD=0.12,95%CI:-0.78-1.01,P=0),6 MWD(WMD=51.39,95%CI:-11.65-114.43,P=0).Conclusion:This meta analysis suggests that stem cell therapy improves LVEF,reduces LVEDCs and NT-proBNP.However,stem cell therapy has no effect on LVESCs,6 MWD.And it wouldn’t impove mortality neither adverse events.Future well designed large studies might be necessary to clarify the effect of stem cell therapy in patients with dilated cardiomyopathy.

关 键 词：干细胞移植 扩张型心肌病 META分析 疗效 

分 类 号：R542.2[医药卫生—心血管疾病]