Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
Chin Med J (Engl). 2013 Jan;126(2):353-60.
The long-term effects of bone marrow-derived cells (BMC) transplantation in patients with acute myocardial infarction (AMI) have not been established. The present meta-analysis of randomized controlled trials with follow-up ≥ 2 years was performed to investigate the long-term effects of BMC therapy in patients after AMI.
Specific terms were used to conduct a systematic literature search of MEDLINE, EMBASE, the Cochrane Library and the Cochrane Central Register of Controlled Trials, and the China Biological Medicine Disk database from their inception to March 2012. A standardized protocol was used to extract information, and random effect model was used to analyze all data except major adverse events.
Five trials comprising 510 patients were included. Compared with controls, BMC therapy significantly improved left ventricular ejection fraction (LVEF) (4.18%, 95%CI: 2.02% to 6.35%, P = 0.0002), while mildly but not significantly reduced left ventricular end-systolic volume (-4.47 ml, 95%CI: -10.92 to 1.99, P = 0.17) and left ventricular end-diastolic volume (-2.29 ml, 95%CI: -9.96 to 5.39, P = 0.56). Subgroup analysis revealed that significant improvement of LVEF induced by BMC therapy could be observed in patients with baseline LVEF ≤ 42%, but disappeared in those with baseline LVEF > 42%. There were trends in favor of BMC therapy for most major clinical adverse events, though most differences were not significant.
Intracoronary BMC infusion in patients with AMI seems to be safe and may further improve LVEF on top of standard therapy; especially the beneficial effects could last for long term. The findings need to be validated in the future.
骨髓来源细胞（BMC）移植治疗急性心肌梗死（AMI）患者的长期疗效尚未确定。本研究通过对随访时间大于等于 2 年的随机对照试验的荟萃分析，旨在探讨 BMC 疗法对 AMI 患者的长期疗效。
采用特定术语，检索 MEDLINE、EMBASE、Cochrane 图书馆和 Cochrane 对照试验中心注册数据库以及中国生物医学文献数据库，检索时间均从建库至 2012 年 3 月。采用标准化方案提取资料，除主要不良事件外，其余资料均采用随机效应模型进行分析。
共纳入 5 项试验，总计 510 例患者。与对照组相比，BMC 治疗组左心室射血分数（LVEF）显著升高（4.18%，95%CI：2.02%~6.35%，P=0.0002），而左心室收缩末期容积（-4.47 ml，95%CI：-10.92 至 1.99，P=0.17）和左心室舒张末期容积（-2.29 ml，95%CI：-9.96 至 5.39，P=0.56）虽略有降低，但差异无统计学意义。亚组分析显示，在基线 LVEF 小于等于 42%的患者中，BMC 治疗可显著改善 LVEF，但在基线 LVEF 大于 42%的患者中，这种改善作用消失。BMC 治疗组在多数主要临床不良事件的发生风险上虽呈下降趋势，但大多数差异无统计学意义。
冠状动脉内输注 BMC 治疗 AMI 似乎是安全的，可在标准治疗的基础上进一步提高 LVEF；且这种有益作用可能长期存在。但这些发现仍需进一步验证。
