Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA.
Osteoarthritis Cartilage. 2018 Jun;26(6):711-729. doi: 10.1016/j.joca.2018.02.906. Epub 2018 Mar 13.
Osteoarthritis (OA) is a leading cause of disability in the world. Mesenchymal stem cells (MSCs) have been studied to treat OA. This review was performed to systematically assess the quality of literature and compare the procedural specifics surrounding MSC therapy for osteoarthritis.
PubMed, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials were searched for studies using MSCs for OA treatment (final search December 2017). Outcomes of interest included study evidence level, patient demographics, MSC protocol, treatment results and adverse events. Level I and II evidence articles were further analyzed.
Sixty-one of 3,172 articles were identified. These studies treated 2,390 patients with osteoarthritis. Most used adipose-derived stem cells (ADSCs) (n = 29) or bone marrow-derived stem cells (BMSCs) (n = 30) though the preparation varied within group. 57% of the sixty-one studies were level IV evidence, leaving five level I and nine level II studies containing 288 patients to be further analyzed. Eight studies used BMSCs, five ADSCs and one peripheral blood stem cells (PBSCs). The risk of bias in these studies showed five level I studies at low risk with seven level II at moderate and two at high risk.
While studies support the notion that MSC therapy has a positive effect on OA patients, there is limited high quality evidence and long-term follow-up. The present study summarizes the specifics of high level evidence studies and identifies a lack of consistency, including a diversity of MSC preparations, and thus a lack of reproducibility amongst these articles' methods.
骨关节炎（OA）是世界范围内导致残疾的主要原因。间充质干细胞（MSCs）已被研究用于治疗 OA。本综述旨在系统评估文献质量，并比较 MSC 治疗 OA 的具体程序。
检索了 PubMed、CINAHL、EMBASE 和 Cochrane 对照试验中心注册数据库，以查找使用 MSC 治疗 OA 的研究（最终检索日期为 2017 年 12 月）。感兴趣的结果包括研究证据水平、患者人口统计学、MSC 方案、治疗结果和不良事件。进一步分析了 I 级和 II 级证据文章。
从 3172 篇文章中确定了 61 篇。这些研究共治疗了 2390 名 OA 患者。大多数研究使用脂肪来源的干细胞（ADSCs）（n=29）或骨髓来源的干细胞（BMSCs）（n=30），尽管组内的制备方法有所不同。61 篇研究中有 57%为 IV 级证据，留下 5 篇 I 级和 9 篇 II 级研究，共包含 288 名患者进行进一步分析。8 项研究使用 BMSCs，5 项使用 ADSCs，1 项使用外周血干细胞（PBSCs）。这些研究的偏倚风险显示，5 项 I 级研究为低风险，7 项 II 级研究为中风险，2 项为高风险。
虽然研究支持 MSC 疗法对 OA 患者有积极影响的观点，但高质量证据和长期随访的证据有限。本研究总结了高水平证据研究的具体情况，并发现了缺乏一致性的问题，包括 MSC 制剂的多样性，以及这些文章方法缺乏可重复性。
