CAJ | 학술논문

目的：系统评价自体外周血干细胞(PBSC)冠状动脉移植治疗心肌梗死的有效性和安全性。方法计算机检索 PubMed(1966年1月至2013年6月)、EMbase(1974年1月至2013年6月)、ISI Web of Knowledge(1945年1月至2013年6月)、Cochrane Library(2013年第6期)、CBM(1978年1月至2013年6月)、VIP(1989年1月至2013年6月)、CNIKI(1915年1月至2013年6月)及 WanFang Data(1996年1月至2013年6月),并辅以手工检索,收集国内外发表的相关随机对照试验(RCT)。两位研究者按照纳入标准筛选文献、提取资料,按照改良 Jadad 评分表评价纳入研究质量,采用 RevMan5.2进行 Meta 分析。结果纳入7个 RCT,合计367例患者。Meta 分析结果显示, PBSC 经冠状动脉移植与常规治疗比较能提高心肌梗死患者的左心室射血分数(LVEF)(MD =3.91%,95% CI =2.30~5.52,P <0.00001),降低左心室收缩末容积(LVESV)[MD =-7.57 ml,95% CI =-12.65~-2.49,P =0.003),但对左心室舒张末容积(LVEDV)无影响(MD =-7.14 ml,95% CI =-14.43~0.14,P =0.05)。亚组分析显示,对急性心肌梗死和慢性心肌梗死患者,PBSC 移植均能提高其 LVEF,降低 LVESV,但对 LVEDV 无影响；移植细胞数<108个能提高心肌梗死患者 LVEF,降低 LVESV,但对 LVEDV 无影响,移植细胞数>108个能提高心肌梗死患者 LVEF,但对 LVESV 和 LVEDV 无影响。结论 PBSC 经冠状动脉移植可以改善心肌梗死患者的心功能,较少的细胞移植数(<108个)可能对心肌梗死患者更有益。其不良反应主要集中在干细胞动员阶段,但远期并发症还需今后更多高质量研究证实。
목적：계통평개자체외주혈간세포(PBSC)관상동맥이식치료심기경사적유효성화안전성。방법계산궤검색 PubMed(1966년1월지2013년6월)、EMbase(1974년1월지2013년6월)、ISI Web of Knowledge(1945년1월지2013년6월)、Cochrane Library(2013년제6기)、CBM(1978년1월지2013년6월)、VIP(1989년1월지2013년6월)、CNIKI(1915년1월지2013년6월)급 WanFang Data(1996년1월지2013년6월),병보이수공검색,수집국내외발표적상관수궤대조시험(RCT)。량위연구자안조납입표준사선문헌、제취자료,안조개량 Jadad 평분표평개납입연구질량,채용 RevMan5.2진행 Meta 분석。결과납입7개 RCT,합계367례환자。Meta 분석결과현시, PBSC 경관상동맥이식여상규치료비교능제고심기경사환자적좌심실사혈분수(LVEF)(MD =3.91%,95% CI =2.30~5.52,P <0.00001),강저좌심실수축말용적(LVESV)[MD =-7.57 ml,95% CI =-12.65~-2.49,P =0.003),단대좌심실서장말용적(LVEDV)무영향(MD =-7.14 ml,95% CI =-14.43~0.14,P =0.05)。아조분석현시,대급성심기경사화만성심기경사환자,PBSC 이식균능제고기 LVEF,강저 LVESV,단대 LVEDV 무영향；이식세포수<108개능제고심기경사환자 LVEF,강저 LVESV,단대 LVEDV 무영향,이식세포수>108개능제고심기경사환자 LVEF,단대 LVESV 화 LVEDV 무영향。결론 PBSC 경관상동맥이식가이개선심기경사환자적심공능,교소적세포이식수(<108개)가능대심기경사환자경유익。기불량반응주요집중재간세포동원계단,단원기병발증환수금후경다고질량연구증실。
Objective To evaluate the efficacy and safety of autologous transplantation of peripheral blood stem cells(PBSC)for myocardial infarction(MI).Methods Relevant randomized clinical trials(RCTs)reported on PubMed (from Jan.1 966 to June 2013),EMbase (from Jan.1 974 to June 2013),ISI Web of Knowledge (from Jan.1 945 to June 2013),Cochrane Library (Issue 6,2013),CBM (from Jan.1 978 to June 2013),VIP (from Jan.1 989 to June 2013),CNKI (from Jan.1 91 5 to June 2013)and WanFang Database (from Jan.1 996 to June 2013)were searched by two reviewers according to the inclusion criteria.Then,the methodological quality of the included studies were evaluated by modified Jadad Scale and the data were analyzed by RevMan 5.2.Results Seven studies including 367 patients were identified.The results of the meta-analysis showed that autologous transplantation of PBSCs could improve the left ventricular ejection fraction(LVEF)(MD = 3.91%,95% CI = 2.30%-5.52%,P < 0.00001 )and reduce the left ventricular end-systolic volume(LVESV)(MD =-7.57 ml,95% CI =-12.65--2.49,P =0.003), but had no effect on the left ventricular end-diastolic volume(LVEDV)(MD = -7.14 ml,95% CI = -14.43-0.14 ml,P =0.05),as compared with the control group.Subgroup analysis revealed that autologous transplantation of PBSCs improved LVEF and reduced LVESV in both acute and chronic MI.Low dose of stem cells improved LVEF and reduced LVESV,but high dose of PBSCs could only improve LVEF.Conclusion The current evidences show that autologous transplantation of PBSCs can improve the left ventricular function for MI patients and low dose of stem cells may have better effects.Future studies should focus on the long term efficacy and safety of autologous transplantation of PBSCs for MI.