Center of Translational Medicine, Jiangsu Key Laboratory of Molecular Medicine, Nanjing University Medical School, Nanjing, China.
Department of Respiratory Medicine, Jiangsu Key Laboratory of Molecular Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Eur J Clin Invest. 2018 Apr;48(4). doi: 10.1111/eci.12894. Epub 2018 Feb 11.
The therapeutic effects of bone marrow-derived mononuclear cells (BMMNCs) transplantation in patients with nonischaemic dilated cardiomyopathy (DCM) are still under debate. Current randomized controlled trials (RCTs) reported conflicting results. The aim of this study was to assess the effects of BMMNCs transplantation on left ventricular ejection fraction (LVEF) in patients with nonischaemic DCM.
A comprehensive search of PubMed, EMBASE and Cochrane Controlled Trials Register was performed. We included RCTs reporting data on LVEF in patients with nonischaemic DCM after BMMNCs transplantation.
Seven RCTs including 463 patients were included. BMMNCs transplantation significantly improved LVEF by 3.79% (95% CI: 0.56%-7.03%; P = .007) and LVESV by -24.36 mL (95% CI: -46.36 to -2.36 mL; P = .03), while had no impact on the risk of all-cause death (OR 0.92; 95% CI: 0.41 to 2.08%; P = .84). Subgroup analysis demonstrated a more significant improvement of LVEF in patients with longer follow-up (~15 months to 5 years) than shorter ones (12 months). Moreover, using bone marrow mononuclear cells was more effective than using G-CSF-stimulated bone marrow/peripheral blood stem cells in the improvement of LVEF in patients with nonischaemic DCM.
Bone marrow-derived mononuclear cells transplantation is associated with a moderate, but significant, improvement in LVEF in patients with nonischaemic DCM. This meta-analysis supports further RCT conductions using BMMNCs transplantation with larger patient's population and longer term follow-up.
骨髓单个核细胞（BMMNCs）移植治疗非缺血性扩张型心肌病（DCM）的疗效仍存在争议。目前的随机对照试验（RCT）报道结果相互矛盾。本研究旨在评估 BMMNCs 移植对非缺血性 DCM 患者左心室射血分数（LVEF）的影响。
系统检索 PubMed、EMBASE 和 Cochrane 对照试验注册库。我们纳入了报道非缺血性 DCM 患者 BMMNCs 移植后 LVEF 数据的 RCT。
纳入了 7 项 RCT，共 463 例患者。BMMNCs 移植可显著提高 LVEF 3.79%（95%CI：0.56%-7.03%；P =.007）和 LVESV-24.36ml（95%CI：-46.36 至-2.36ml；P =.03），但对全因死亡风险无影响（OR 0.92；95%CI：0.41 至 2.08%；P =.84）。亚组分析显示，随访时间较长（~15 个月至 5 年）的患者 LVEF 改善更显著，而随访时间较短（12 个月）的患者则无显著改善。此外，与使用 G-CSF 刺激的骨髓/外周血干细胞相比，使用骨髓单个核细胞在改善非缺血性 DCM 患者的 LVEF 方面更有效。
骨髓来源的单个核细胞移植可使非缺血性 DCM 患者的 LVEF 适度且显著改善。本荟萃分析支持进一步开展使用 BMMNCs 移植的 RCT，纳入更多患者并进行更长时间的随访。
