时间对急性心肌梗死患者冠状动脉内自体骨髓干细胞移植疗效和安全性的影响：随机对照试验的汇总亚组分析
Impact of timing on efficacy and safetyof intracoronary autologous bone marrow stem cells transplantation in acute myocardial infarction: a pooled subgroup analysis of randomized controlled trials.
作者信息
Zhang Shuning, Sun Aijun, Xu Danling, Yao Kang, Huang Zheyong, Jin Huan, Wang Keqiang, Zou Yunzeng, Ge Junbo
机构信息
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
出版信息
Clin Cardiol. 2009 Aug;32(8):458-66. doi: 10.1002/clc.20575.
BACKGROUND
Until now there were no clinical studies or systematic reviews to investigate the impact of timing on efficacy and safety of intracoronary bone marrow stem cell (BMSC) transfer in patients with acute myocardial infarction (AMI).
HYPOTHESIS
Timing of BMSC administration might play an important role in the therapeutic response in AMI patients.
METHODS
A systematic literature search of PubMed, MEDLINE, and Cochrane Evidence-Based Medicine (EBM) databases was made on randomized controlled trials with at least 3-month follow-up data for patients with AMI undergoing emergent percutaneous coronary intervention (PCI) and receiving intracoronary BMSC transfer thereafter.
RESULTS
A total of 7 trials with 660 patients were available for analysis. Compared to baseline level, BMSC transfer at 4 to 7 days post-AMI significantly improved left ventricular ejection fraction (LVEF; 4.63% increase, 95% confidence interval [CI]: 1.00%-8.26%, P = 0.01), reduced left ventricular (LV) end-systolic dimensions (95% CI: - 0.53 - 0.02, P = 0.03), decreased the incidences of revascularization (odds ratio [OR]: 0.60, 95% CI: 0.37-0.97, P = 0.04), decreased the cumulative clinical events of death or recurrent myocardial infarction (OR: 0.32, 95% CI: 0.11-0.95, P = 0.04), and decreased culprit artery restenosis or ventricular arrhythmia (OR: 0.59, 95% CI: 0.36-0.96, P = 0.03) however these improvements did not reach statistical significance in emergent transfer trials (within 24 hour post-AMI). Compared with emergent transfer, intracoronary BMSC therapy at 4 to 7 days also significantly reduced the incidence of revascularization (P for interaction = 0.02).
CONCLUSIONS
BMSC transfer at 4 to 7 days post-AMI was superior to that within 24 hours in improving LVEF, decreasing LV end-systolic dimensions, and reducing the incidence of revascularization.
背景
迄今为止，尚无临床研究或系统评价来探究急性心肌梗死（AMI）患者冠状动脉内骨髓干细胞（BMSC）移植时机对疗效和安全性的影响。
假设
BMSC给药时机可能在AMI患者的治疗反应中起重要作用。
方法
对PubMed、MEDLINE和Cochrane循证医学（EBM）数据库进行系统文献检索，纳入对接受紧急经皮冠状动脉介入治疗（PCI）并随后接受冠状动脉内BMSC移植的AMI患者进行至少3个月随访数据的随机对照试验。
结果
共有7项试验、660例患者可供分析。与基线水平相比，AMI后4至7天进行BMSC移植可显著提高左心室射血分数（LVEF；增加4.63%，95%置信区间[CI]：1.00%-8.26%，P = 0.01），减小左心室（LV）收缩末期内径（95% CI：-0.53 - 0.02，P = 0.03），降低血运重建发生率（比值比[OR]：0.60，95% CI：0.37-0.97，P = 0.04），降低死亡或复发性心肌梗死的累积临床事件发生率（OR：0.32，95% CI：0.11-0.95，P = 0.04），以及降低罪犯血管再狭窄或室性心律失常发生率（OR：0.59，95% CI：0.36-0.96，P = 0.03），然而在紧急移植试验（AMI后24小时内）中这些改善未达到统计学意义。与紧急移植相比，4至7天进行冠状动脉内BMSC治疗也显著降低了血运重建发生率（交互作用P = 0.02）。
结论
AMI后4至7天进行BMSC移植在改善LVEF、减小LV收缩末期内径和降低血运重建发生率方面优于24小时内进行移植。
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