Xu Jia-Ying, Cai Wen-Yuan, Tian Ming, Liu Dai, Huang Rong-Chong
The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China.
Chronic Dis Transl Med. 2016 Nov 9;2(2):92-101. doi: 10.1016/j.cdtm.2016.09.006. eCollection 2016 Jun.
To evaluate whether stem cell transplantation improves global left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction (AMI), and to determine the appropriate stem cell therapy dose as well as the effective period after stem cell transplantation for therapy.
A systematic literature search included Pubmed, MEDLINE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Cochrane Evidence-Based Medicine databases. The retrieval time limit ranged from January 1990 to June 2016. We also obtained full texts through manual retrieval, interlibrary loan and document delivery service, or by contacting the authors directly. According to our inclusion and exclusion criteria, data were extracted independently by two evaluators. In case of disagreement, a joint discussion occurred and a third researcher was utilized. Data were analyzed quantitatively using Revman 5.2. Summary results are presented as the weighted mean difference (WMD) with 95% confidence intervals (s). We collected individual trial data and conducted a meta-analysis to compare changes in global left ventricular ejection fraction (ΔLVEF) after stem cell therapy. In this study, four subgroups were based on stem cell dose (≤1 × 10 cells, ≤1 × 10 cells, ≤1 × 10 cells, and ≤1 × 10 cells) and three subgroups were based on follow-up time (<6 months, 6-12 months, and ≥12 months).
Thirty-four studies, which included 40 randomized controlled trials, were included in this meta-analysis, and 1927 patients were evaluated. Changes in global LVEF were significantly higher in the stem cell transplantation group than in the control group (: 2.35-4.26%, < 0.01). We found no significant differences in ΔLVEF between the bone marrow stem cells (BMCs) group and control group when the dose of BMCs was ≤1 × 10 [ΔLVEF : 0.12-3.96%, = 0.04]. The ΔLVEF in the BMCs groups was significantly higher than in the control groups when the dose of BMCs was ≤1 × 10 [ΔLVEF : 0.95-4.25%, = 0.002] and ≤1 × 10 [ΔLVEF : 2.31-4.20%, < 0.01]. In addition, when the dose of BMCs was between 10 and 10 cells, we did not observe any significant differences [ΔLVEF : -0.99-11.82%, = 0.10]. Our data suggest stem cell therapy improves cardiac function in AMI patients when treated with an appropriate dose of BMCs.
Stem cell transplantation after AMI could improve global LVEF. Stem cells may be effectively administered to patients with AMI doses between 10 and 10 cells.
评估干细胞移植是否能改善急性心肌梗死（AMI）患者的整体左心室射血分数（LVEF），并确定合适的干细胞治疗剂量以及干细胞移植后有效的治疗期限。
进行系统的文献检索，包括PubMed、MEDLINE、中国知网（CNKI）、中国生物医学文献数据库（CBM）和Cochrane循证医学数据库。检索时间范围为1990年1月至2016年6月。我们还通过手工检索、馆际互借和文献传递服务或直接联系作者获取全文。根据我们的纳入和排除标准，由两名评估人员独立提取数据。如有分歧，则进行联合讨论并引入第三名研究人员。使用Revman 5.2对数据进行定量分析。汇总结果以加权平均差（WMD）及95%置信区间表示。我们收集了个体试验数据并进行荟萃分析，以比较干细胞治疗后整体左心室射血分数的变化（ΔLVEF）。在本研究中，四个亚组基于干细胞剂量（≤1×10⁶细胞、≤1×10⁷细胞、≤1×10⁸细胞和≤1×10⁹细胞），三个亚组基于随访时间（<6个月、6 - 12个月和≥12个月）。
本荟萃分析纳入了34项研究，其中包括40项随机对照试验，共评估了1927例患者。干细胞移植组的整体LVEF变化显著高于对照组（WMD：2.35 - 4.26%，P < 0.01）。当骨髓干细胞（BMCs）剂量≤1×10⁶时，我们发现BMCs组与对照组之间的ΔLVEF无显著差异（ΔLVEF：0.12 - 3.96%，P = 0.04）。当BMCs剂量≤1×10⁷时，BMCs组的ΔLVEF显著高于对照组（ΔLVEF：0.95 - 4.25%，P = 0.002），当BMCs剂量≤1×10⁸时也显著高于对照组（ΔLVEF：2.31 - 4.20%，P < 0.01）。此外，当BMCs剂量在10⁷和10⁸细胞之间时，我们未观察到任何显著差异（ΔLVEF： - 0.99 - 11.82%，P = 0.10）。我们的数据表明，用适当剂量的BMCs治疗时，干细胞疗法可改善AMI患者的心脏功能。
AMI后进行干细胞移植可改善整体LVEF。对于AMI患者，可有效给予剂量在10⁷和10⁸细胞之间的干细胞。
