Chen Xiuqi, Sun Wenbo, Zhong Ping, Wu Danhong
Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
Department of Neurology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China.
Front Pharmacol. 2021 Jul 22;12:704509. doi: 10.3389/fphar.2021.704509. eCollection 2021.
CSF therapy is considered a promising therapeutic approach for stroke. We performed a meta-analysis to explore the safety and efficacy of CSF in published clinical stroke studies. We searched articles online and manually. Two reviewers selected studies independently, selecting data based on study quality, characteristics of intervention (administration time, observation time, type, dose, and injection approach of CSF), and the baseline characteristics of patients (age, sex, hypertension, diabetes, smoker, and lipids) were extracted. Main prognosis outcomes were measured as all-cause death in severe adverse events (SAE) and recurrent stroke in SAE. Secondary outcomes were measured as CD34+ cell counts in periphery blood at day 5, National Institutes of Health Stroke Scale (NIHSS), and Barthel index (BI), Side effects of CSF were taken as the indicator of safety. STATA13 software was used to perform the meta-analysis.Keywords: Stroke, Colony-stimulating factor, Meta-analysis, therapy, Neurological Diseases This meta-analysis involved 485 patients from eight studies. Among them, 475 patients from seven studies were gauged SAE (all-cause death), 393 patients from six studies were checked SAE (recurrent stroke); 137 patients from three studies underwent CD34 measurement, 389 patients from six studies were tested NIHSS and 307 patients from five studies accessed BI. Compared with the control group, both all-causes death (RR= 1.73, 95%CI= (0.61, 4.92), P=0.735, I=0.0%) and recurrent stroke (RR= 0.43, 95%CI= (0.14, 1.32), P=0.214, I=33.1%) present no statistical differences, indicating that the application of CSF does not statistically alter the prognosis of patients with stroke. The application of CSF effectively enhanced CD34+ cell counts in periphery blood at day 5 (SMD= 1.23, 95%CI= (0.54, 1.92), P=0.04, I=69.0%) but did not statistically impact NIHSS (SMD= -0.40, 95%CI= (-0.93, 0.13), P ≤ 0.001, I=79.7%) or BI (SMD= 0.04, 95%CI= (-0.38, 0.46), P=0.068, I=54.3%). Our study consolidates the security of CSF administration for its exerting no effect on detrimental outcomes. It has proven to be effective in elevating CD34+ cell counts in periphery blood at day 5, indicating CSF may participate in stroke recovery, but its efficacy in stroke recovery remains detected.
脑脊液疗法被认为是一种有前景的中风治疗方法。我们进行了一项荟萃分析，以探讨已发表的临床中风研究中脑脊液的安全性和有效性。我们通过在线和手动方式搜索文章。两名评审员独立选择研究，根据研究质量、干预特征（脑脊液的给药时间、观察时间、类型、剂量和注射方法）以及患者的基线特征（年龄、性别、高血压、糖尿病、吸烟者和血脂）提取数据。主要预后结果以严重不良事件（SAE）中的全因死亡和SAE中的复发性中风来衡量。次要结果以第5天外周血中CD34+细胞计数、美国国立卫生研究院卒中量表（NIHSS）和巴氏指数（BI）来衡量。脑脊液的副作用作为安全性指标。使用STATA13软件进行荟萃分析。关键词：中风、集落刺激因子、荟萃分析、治疗、神经疾病 这项荟萃分析涉及八项研究中的485名患者。其中，七项研究中的475名患者被评估为SAE（全因死亡），六项研究中的393名患者接受了SAE检查（复发性中风）；三项研究中的137名患者进行了CD34测量，六项研究中的389名患者接受了NIHSS测试，五项研究中的307名患者接受了BI评估。与对照组相比，全因死亡（RR = 1.73，95%CI = (0.61, 4.92)，P = 0.735，I = 0.0%）和复发性中风（RR = 0.43，95%CI = (0.14, 1.32)，P = 0.214，I = 33.1%）均无统计学差异，表明脑脊液的应用在统计学上不会改变中风患者的预后。脑脊液的应用在第5天有效提高了外周血中CD34+细胞计数（SMD = 1.23，95%CI = (0.54, 1.92)，P = 0.04，I = 69.0%），但对NIHSS（SMD = -0.40，95%CI = (-0.93, 0.13)，P ≤ 0.001，I = 79.7%）或BI（SMD = 0.04，95%CI = (-0.38, 0.46)，P = 0.068，I = 54.3%）没有统计学影响。我们的研究证实了脑脊液给药的安全性，因为它对有害结果没有影响。已证明它在提高第5天外周血中CD34+细胞计数方面是有效的，表明脑脊液可能参与中风恢复，但其在中风恢复中的疗效仍有待检测。
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