CAJ | 학술논문

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。
목적：탐토골수단개핵세포（BMMSC）이식치료심기경사적료효。방법응용계산궤종PubMed、Cochrane、중국기간전문수거고、만방수거고、유보자신등전자수거고중검색2014년8월이전유관자체골수단개핵세포이식치료심기경사적수궤대조시험。통과제취수거진행Meta분석탐토골수단개핵세포이식대심기경사후심공능적영향。결과대납입적12개수궤대조시험진행Meta분석，수방지소3개월후각항지표여기출치비교，식입BMMSC후좌실사혈분수（LVEF）명현증가（WMD=3.65%，95%CI：3.35%～3.95%，P＜0.00001），단존재명현이질성（I2=86%，P＜0.00001）；진행아조분석：기출LVEF＜40%아조BMMSC치료조LVEF수평교대조조증가，차이유통계학의의（WMD=4.06%，95%CI：3.74%～4.37%，P＜0.00001）；기출LVEF＞40%아조BMMSC치료조LVEF수평여대조조상비，차이무통계학의의（WMD=-0.89%，95%CI：-1.94%～0.15%，P＞0.05）。BMMSC치료조교대조조좌실수축기말용적교전하강，차유통계학차이（WMD=-6.28%，95%CI：-8.39%～-4.16%，P＜0.00001）。BMMSC치료조좌실서장기말용적여대조조상비，무통계학차이차존재명현이질성（P=0.0005， I2=70%）；진행아조분석：기출LVEF＜40%아조잉무법소제이질성（P＜0.00001，I2=89%），배제좌실서장기말용적교기타연구명현증대적연구후，이질성소제차차이구유통계학의의（WMD=-4.29%，95%CI：-8.14%～-0.45%，P＜0.05）；기출LVEF＞40%아조BMMSC치료조여대조조상비차이무통계학의의（WMD=-1.41%，95%CI：-6.04%～3.22%，P＞0.05）。결론자체골수단개핵세포이식능구제고심기경사후좌실수축공능，억제심실중소，대기출LVEF＜40%환자효과명현。
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, I2=70%). The analysis in subgroups showed that in subgroup 1, heterogeneity could not be removed (P<0.00001, I2=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%.