Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt.
Department of Cardiac Surgery, Heart Center University, Medicine Leipzig, Leipzig, Germany.
Ann Thorac Surg. 2019 Dec;108(6):1913-1921. doi: 10.1016/j.athoracsur.2019.05.094. Epub 2019 Aug 6.
Although the safety and feasibility of combined coronary artery bypass grafting (CABG) and bone marrow stem cell (BMSC) transplantation have been proven, the efficacy of this approach remains controversial. Therefore, we conducted an updated meta-analysis of randomized controlled trials to evaluate the efficacy of this procedure.
Electronic databases were systematically searched for randomized trials comparing 4-month to 6-month follow-up outcomes in patients who underwent isolated CABG (CABG group) and patients who received BMSC transplantation with CABG (BMSC group). A random-effects meta-analysis was conducted across eligible studies. Meta-regression and subgroup analyses were utilized to identify sources of data heterogeneity.
Thirteen trials were eligible, with a total number of 292 patients in the BMSC group and 247 patients in the CABG group. Compared with the CABG group, the BMSC group showed significant improvement of follow-up left ventricular ejection fraction (n = 539, 4.8%; 95% confidence interval [CI], 2.3%-7.3%; P = .001). The analyzed data showed significant heterogeneity (I = 74.2%, P < .001). The reduction in scar size (n = 120; -2.2 mL; 95% CI, -18.2 mL to 13.7 mL; P = .44) and the improvement in the 6-minute walk test (n = 212; 41 m; 95% CI, -13 m to 95 m; P = .10) did not reach statistical significance. No significant correlation was found between the number of the injected BMSCs or the method of injection and the change in ejection fraction.
The present evidence suggests that combined CABG and BMSC transplantation is associated with improvement of left ventricular ejection fraction. However, the heterogeneity in the data suggests variations in patient response to this therapy. Further studies are required to understand these variations.
虽然联合冠状动脉旁路移植术（CABG）和骨髓干细胞（BMSC）移植的安全性和可行性已得到证实，但该方法的疗效仍存在争议。因此，我们对随机对照试验进行了更新的荟萃分析，以评估该方法的疗效。
系统地检索了电子数据库，以比较接受单纯 CABG（CABG 组）和 CABG 联合 BMSC 移植（BMSC 组）的患者在 4 至 6 个月随访期间的结果的随机对照试验。对合格研究进行了随机效应荟萃分析。采用元回归和亚组分析来确定数据异质性的来源。
共有 13 项试验符合条件，BMSC 组共 292 例患者，CABG 组共 247 例患者。与 CABG 组相比，BMSC 组的随访左心室射血分数（n=539，4.8%；95%置信区间，2.3%-7.3%；P=0.001）显著改善。分析数据显示存在显著的异质性（I=74.2%，P<.001）。疤痕大小的减少（n=120；-2.2 毫升；95%置信区间，-18.2 毫升至 13.7 毫升；P=0.44）和 6 分钟步行试验的改善（n=212；41 米；95%置信区间，-13 米至 95 米；P=0.10）未达到统计学意义。未发现注入的 BMSC 数量或注入方法与射血分数变化之间存在显著相关性。
目前的证据表明，联合 CABG 和 BMSC 移植与左心室射血分数的改善相关。然而，数据的异质性表明患者对这种治疗的反应存在差异。需要进一步的研究来了解这些差异。
