Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Am J Cardiol. 2013 Jul 15;112(2):217-25. doi: 10.1016/j.amjcard.2013.03.021. Epub 2013 Apr 24.
Studies investigating bone marrow stem cell therapy (BMSCT) in patients with chronic ischemic cardiomyopathy have yielded mixed results. A meta-analysis of randomized controlled trials of BMSCT in patients with chronic ischemic cardiomyopathy was undertaken to assess its efficacy and the best route of administration. The MEDLINE, Embase, Cumulative Index to Nursing & Allied Health Literature, and Cochrane Library databases were searched through April 2012 for randomized controlled trials that investigated the impact of BMSCT and its route of administration on left ventricular (LV) function in patients with chronic ischemic cardiomyopathy and systolic dysfunction. Of the 226 reports identified, 10 randomized controlled trials including 519 patients (average LV ejection fraction [LVEF] at baseline 32 ± 7%) were included in the analysis. On the basis of a random-effects model, BMSCT improved the LVEF at 6 months by 4.48% (95% confidence interval [CI] 2.43% to 6.53%, p = 0.0001). A greater improvement in the LVEF was seen with intramyocardial injection compared with intracoronary infusion (5.13% [95% CI 3.17% to 7.10%], p <0.00001, vs 2.32% [95% CI -2.06% to 6.70%], p = 0.30). Overall, there were reductions in LV end-systolic volume of -20.64 ml (95% CI -33.21 to -8.07, p = 0.001) and LV end-diastolic volume of -16.71 ml (95% CI -31.36 to -2.06, p = 0.03). In conclusion, stem cell therapy may improve LVEF and favorably remodel the heart in patients with chronic ischemic cardiomyopathy. On the basis of current limited data, intramyocardial injection may be superior to intracoronary infusion in patients with LV systolic dysfunction.
研究调查骨髓干细胞治疗（BMSCT）在慢性缺血性心肌病患者中的疗效，结果喜忧参半。本研究对慢性缺血性心肌病患者行 BMSCT 的随机对照试验进行荟萃分析，以评估其疗效和最佳给药途径。通过 MEDLINE、Embase、护理学和联合健康文献累积索引以及 Cochrane 图书馆数据库，检索至 2012 年 4 月，以评估 BMSCT 及其给药途径对慢性缺血性心肌病和收缩功能障碍患者左心室（LV）功能的影响。在 226 份报告中，有 10 项随机对照试验（共 519 例患者，平均基线 LV 射血分数[LVEF]为 32±7%）纳入分析。基于随机效应模型，BMSCT 可使 6 个月时 LVEF 提高 4.48%（95%置信区间[CI]：2.43%至 6.53%，p=0.0001）。与冠状动脉内输注相比，心肌内注射可使 LVEF 更大程度地提高（5.13%[95%CI：3.17%至 7.10%]，p<0.00001，vs 2.32%[95%CI：-2.06%至 6.70%]，p=0.30）。总体而言，LV 收缩末期容积减少了-20.64ml（95%CI：-33.21 至-8.07，p=0.001），LV 舒张末期容积减少了-16.71ml（95%CI：-31.36 至-2.06，p=0.03）。总之，干细胞治疗可能改善慢性缺血性心肌病患者的 LVEF，并使心脏重塑有利。基于目前有限的数据，在 LV 收缩功能障碍患者中，心肌内注射可能优于冠状动脉内输注。
