[自体骨髓来源细胞移植治疗慢性缺血性心脏病患者的疗效：一项荟萃分析]

[Efficacy of autologous bone marrow-derived cells transfer for patients with chronic ischemic heart disease: a meta-analysis].

作者信息

Zhang Chun-yu, Sun Ai-jun, Ge Jun-bo, Zhang Shu-ning, Wang Ke-qiang, Zou Yun-zeng

机构信息

Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Jul;38(7):656-61.

PMID:21055294

Abstract

OBJECTIVE

We aimed to perform a meta-analysis of clinical trials on the efficacy of autologous bone marrow-derived cells (BMCs) transfer for patients with chronic ischemic heart disease.

METHODS

We searched MEDLINE, EMBASE, and Cochrane database through September 2009. Eligible studies were randomized controlled trials of autologous BMCs infusion in patients with chronic ischemic heart disease. We gathered information about left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and death, and did a random-effect meta-analysis to obtain summary effect estimates for outcomes. The pooled analyses were performed and forest plots were generated with RevMan 5.0 software. Heterogeneity was assessed by meta-regression with STATA 10.0 software. Additionally, subgroup analysis was performed to compare the effect of intracoronary BMCs transfer with intramyocardial cell injection on LVEF.

RESULTS

Eleven trials with 490 participants were identified. There were 268 patients in BMCs group, and 222 in control group. In control group, the patients received saline injection or autologous plasma injection or no injection. BMCs transfer was performed via intracoronary transfer or intramyocardial injection. Compared with controls, BMCs transfer significantly improved LVEF by 4.63% (95%CI 2.42 to 6.84; P < 0.01). BMCs transfer was also associated with significant reductions in LVEDV (standardized mean difference -0.55, 95%CI -0.94 to -0.17, P = 0.005) and LVESV (standardized mean difference -0.45, 95%CI -0.73 to -0.17, P = 0.002). In addition, BMCs treatment was associated with a significant effect on death (OR 0.42, 95%CI 0.18 to 1.01, P = 0.05). Subgroup analysis indicated that intramyocardial cell injection was preferred due to its more significant improvement of LVEF than intracoronary cell therapy. Meta-regression suggested the existence of a negative association between baseline LVEF and LVEF change.

CONCLUSION

BMCs infusion is associated with a significant improvement in LVEF, and an attenuation of left ventricular remodeling.

摘要

目的

我们旨在对自体骨髓源细胞（BMCs）移植治疗慢性缺血性心脏病患者疗效的临床试验进行荟萃分析。

方法

我们检索了截至2009年9月的MEDLINE、EMBASE和Cochrane数据库。符合条件的研究为慢性缺血性心脏病患者自体BMCs输注的随机对照试验。我们收集了左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）及死亡情况的信息，并进行随机效应荟萃分析以获得各结局的汇总效应估计值。使用RevMan 5.0软件进行汇总分析并生成森林图。使用STATA 10.0软件通过Meta回归评估异质性。此外，进行亚组分析以比较冠状动脉内BMCs移植与心肌内细胞注射对LVEF的影响。

结果

共纳入11项试验，490名参与者。BMCs组有268例患者，对照组有222例患者。在对照组中，患者接受生理盐水注射、自体血浆注射或不注射。BMCs移植通过冠状动脉内移植或心肌内注射进行。与对照组相比，BMCs移植使LVEF显著提高了4.63%（95%CI 2.42至6.84；P<0.01）。BMCs移植还与LVEDV显著降低（标准化均数差值-0.55，95%CI -0.94至-0.17，P = 0.005）和LVESV显著降低（标准化均数差值-0.45，95%CI -0.73至-0.17，P = 0.002）相关。此外，BMCs治疗对死亡有显著影响（OR 0.42，95%CI 0.18至1.01，P = 0.05）。亚组分析表明，心肌内细胞注射更受青睐，因为其对LVEF的改善比冠状动脉内细胞治疗更显著。Meta回归表明基线LVEF与LVEF变化之间存在负相关。