自体干细胞移植治疗病毒性肝炎相关性肝硬化患者：系统评价和荟萃分析。

Autologous stem cell transplantation for patients with viral hepatitis-induced liver cirrhosis: a systematic review and meta-analysis.

机构信息

Center of Infectious Diseases, West China Hospital of Sichuan University.

West China School of Medicine, Sichuan University, Chengdu, People's Republic of China.

出版信息

Eur J Gastroenterol Hepatol. 2019 Oct;31(10):1283-1291. doi: 10.1097/MEG.0000000000001455.

DOI:10.1097/MEG.0000000000001455

PMID:31206409

Abstract

BACKGROUND

Recently, stem cells have been used in the treatment of viral hepatitis-induced liver cirrhosis (LC), and stem cell therapy is showing potential therapeutic effects on liver function improvement. The consensus on effects and safety of stem cell therapy has not been reached, thus it is essential for us to conduct a systematic review and meat-analysis to investigate the efficacy and safety of stem cell therapy for viral hepatitis-induced LC.

MATERIALS AND METHODS

Medline, Embase, SinoMed and Cochrane Library databases were searched with appropriate keywords through 5 August 2018. We included eight trials involving 467 patients. The pooled weight mean difference (WMD) and 95% confidence interval (CI) were calculated using a fixed or random effects model. Quality assessment and publication bias were also performed. The selected studies were considered for meta-analysis using RevMan V5.3.

RESULTS

Compared with traditional therapy group, autologous stem cell transplantation increased the level of albumin (WMD: 2.47, 95% CI: 1.05-3.90, P < 0.001), but decreased the level of total bilirubin (WMD: -2.26, 95% CI: -3.61 to -0.90, P = 0.001), alanine aminotransferase (WMD: -9.16, 95% CI: -16.47 to -1.85, P = 0.01) and prothrombin time (WMD: -3.02, 95% CI: -4.83 to -1.22, P = 0.001). Clinical symptoms such as edema, fatigue, anorexia and abdominal distention were alleviated. Model for End-Stage Liver Disease and Child-Pugh scores were decreased after stem cell therapy. Whereas, there was no statistically significant difference between two groups regarding aspartate aminotransferase, prothrombin time activity, ascites and pleural fluid. No procedure-related complications were found.

CONCLUSION

Autologous stem cell transplantation might have beneficial effects on patients with viral hepatitis-induced LC and is relatively safe for these patients. Further high-quality randomized controlled trials are needed.

摘要

背景

最近，干细胞已被用于治疗病毒性肝炎引起的肝硬化（LC），并且干细胞治疗在改善肝功能方面显示出潜在的治疗效果。对于干细胞治疗的效果和安全性尚未达成共识，因此我们有必要进行系统评价和荟萃分析，以调查干细胞治疗病毒性肝炎引起的 LC 的疗效和安全性。

材料和方法

通过适当的关键词，检索了 Medline、Embase、SinoMed 和 Cochrane Library 数据库，截至 2018 年 8 月 5 日。我们纳入了八项涉及 467 名患者的试验。使用固定或随机效应模型计算汇总加权均数差（WMD）和 95%置信区间（CI）。还进行了质量评估和发表偏倚。使用 RevMan V5.3 对选定的研究进行了荟萃分析。

结果

与传统治疗组相比，自体干细胞移植增加了白蛋白水平（WMD：2.47，95%CI：1.05-3.90，P<0.001），但降低了总胆红素水平（WMD：-2.26，95%CI：-3.61 至-0.90，P=0.001）、丙氨酸氨基转移酶（WMD：-9.16，95%CI：-16.47 至-1.85，P=0.01）和凝血酶原时间（WMD：-3.02，95%CI：-4.83 至-1.22，P=0.001）。水肿、疲劳、厌食和腹胀等临床症状得到缓解。干细胞治疗后，终末期肝病模型和 Child-Pugh 评分降低。然而，两组间天门冬氨酸氨基转移酶、凝血酶原时间活动度、腹水和胸腔积液无统计学差异。未发现与操作相关的并发症。