Cao Yantian, Ding Zhen, Han Chaoqun, Shi Huiying, Cui Lianlian, Lin Rong
Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China.
Dig Dis Sci. 2017 Apr;62(4):851-860. doi: 10.1007/s10620-017-4453-x. Epub 2017 Feb 6.
The introduction of mesenchymal stromal cells (MSCs) has changed the management of Crohn's fistula, while it remains controversial. The aim of this study was to provide an overview of efficacy and optimum state of MSCs treatment on Crohn's fistula.
Studies reporting MSCs treatment on Crohn's fistula were searched and included. A fixed-effects model was used to assess the efficacy of MSCs, and outcomes of healing and recurrence were used to evaluate the best states of MSCs intervention.
Fourteen articles were enrolled (n = 477). Pooled analysis showed MSCs had a significant efficacy compared to other treatments [risk difference: 0.21 (0.09, 0.32), P = 0.000]. Notably, after MSCs treatment, the group of Crohn's disease activity index (CDAI) baseline >150 group had a higher healing rate (HR) and a clinical response (a change in CDAI of >50 points) (79.17 ± 8.78 vs. 47.54 ± 15.90, P = 0.011) compared to CDAI baseline of <150. The duration time of CD and fistulas had a negative correlation with HR accompanied by MSC therapy (r = -0.900, -0.925). Then, a moderate dose MSCs (2-4 × 10 cells/ml) had a higher HR (80.07%) and lower recurrence rate (RR 13.98%) compared to other dosages. Moreover, adipose-derived MSCs therapy had an advantage over bone marrow-derived MSCs in terms of low RR (7.4 ± 4.28 vs. 13.39 ± 0.89).
The evidence supported the effect of MSCs at a more appropriate time of Crohn's fistula. And CDAI baseline (the points >150) has been a candidate for evaluating effectiveness of MSCs application on Crohn's fistula.
间充质基质细胞（MSCs）的引入改变了克罗恩病肛瘘的治疗方式，但仍存在争议。本研究旨在概述MSCs治疗克罗恩病肛瘘的疗效及最佳状态。
检索并纳入报道MSCs治疗克罗恩病肛瘘的研究。采用固定效应模型评估MSCs的疗效，并使用愈合和复发结果来评估MSCs干预的最佳状态。
纳入14篇文章（n = 477）。汇总分析显示，与其他治疗相比，MSCs具有显著疗效[风险差异：0.21（0.09，0.32），P = 0.000]。值得注意的是，MSCs治疗后，克罗恩病活动指数（CDAI）基线>150分的组与CDAI基线<150分的组相比，愈合率（HR）和临床反应（CDAI变化>50分）更高（79.17±8.78对47.54±15.90，P = 0.011）。克罗恩病和肛瘘的病程与MSCs治疗后的HR呈负相关（r = -0.900，-0.925）。然后，与其他剂量相比，中等剂量的MSCs（2 - 4×10细胞/ml）具有更高的HR（80.07%）和更低的复发率（RR 13.98%）。此外，在低RR方面，脂肪来源的MSCs治疗优于骨髓来源的MSCs（7.4±4.28对13.39±0.89）。
证据支持在克罗恩病肛瘘更合适的时间使用MSCs的效果。并且CDAI基线（>150分）已成为评估MSCs应用于克罗恩病肛瘘有效性的一个指标。
