Department of Critical Care Medicine of Liver Disease, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine of Liver Disease, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Transl Res. 2018 Oct;200:65-80. doi: 10.1016/j.trsl.2018.05.006. Epub 2018 Jun 23.
Acute-on-chronic liver failure (ACLF) is a serious life-threatening disease with high prevalence. Liver transplantation is the only efficient clinical treatment for ACLF. Because of the rapid progression and lack of liver donors, it is urgent to find an effective and safe therapeutic approach to ACLF. Recent studies showed that multipotent cell transplantation could improve the patients' liver function and enhance their preoperative condition. Cells such as mesenchymal stem cells, bone marrow mononuclear cells and autologous peripheral blood stem cells, which addressed in this study have all been used in multipotent cell transplantation for liver diseases. However, its clinical efficiency is still debatable. This systematic review and meta-analysis explored the clinical efficiency of multipotent cell transplantation as a therapeutic approach for patients with ACLF. A detailed search of the Cochrane Library, MEDLINE, and Embase databases was conducted from inception to November 2017. The outcome measures were serum albumin, prothrombin time, alanine aminotransferase, total bilirubin, platelets, hemoglobin, white blood cells, and survival time. The quality of evidence was assessed using GRADEpro and Jaded scores. A literature search resulted in 537 citations. Of these, 9 articles met the inclusion criteria. It was found that multipotent cell transplantation was able to alleviate liver damage and improve liver function. Multipotent cell transplantation can also enhance the short-term and medium-term survival rates of ACLF. All 9 research articles included in this analysis reported no statistically significant adverse events, side effects, or complications. In conclusions, this study suggested that multipotent cell transplantation could be recommended as a potential therapeutic supplementary tool in clinical practice. However, clinical trials in large-volume centers still needed.
慢性加急性肝衰竭（ACLF）是一种严重的危及生命的疾病，其发病率较高。肝移植是治疗 ACLF 的唯一有效临床方法。由于疾病进展迅速且供肝缺乏，因此迫切需要寻找一种有效且安全的 ACLF 治疗方法。最近的研究表明，多能干细胞移植可以改善患者的肝功能并增强其术前状况。本研究中涉及的细胞，如间充质干细胞、骨髓单个核细胞和自体外周血干细胞，已被用于肝疾病的多能干细胞移植。然而，其临床疗效仍存在争议。本系统评价和荟萃分析探讨了多能干细胞移植作为 ACLF 患者治疗方法的临床疗效。从建库到 2017 年 11 月，详细检索了 Cochrane 图书馆、MEDLINE 和 Embase 数据库。结局指标为血清白蛋白、凝血酶原时间、丙氨酸转氨酶、总胆红素、血小板、血红蛋白、白细胞和生存时间。使用 GRADEpro 和 Jadad 评分评估证据质量。文献检索产生了 537 条引文。其中，9 篇文章符合纳入标准。结果发现，多能干细胞移植能够减轻肝损伤并改善肝功能。多能干细胞移植还可以提高 ACLF 的短期和中期生存率。本分析中纳入的所有 9 项研究均未报告有统计学意义的不良事件、副作用或并发症。总之，本研究表明，多能干细胞移植可以作为临床实践中潜在的治疗辅助手段推荐。但是，仍需要在大样本中心开展临床试验。
