Liu Shuangyan, Zhang Huai, Wang Haiyan, Huang Juan, Yang Yi, Li Guoxiang, Yu Kuai, Yang Lei
Medical School, Hangzhou Normal University, Hangzhou 310000, China; Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Medical School, Hangzhou Normal University, Hangzhou 310000, China.
World Neurosurg. 2022 Mar;159:e232-e243. doi: 10.1016/j.wneu.2021.12.035. Epub 2021 Dec 22.
In the present study, we evaluated the efficacy and safety of different stem cell types for spinal cord injury (SCI) therapy to determine the superior treatment of SCI.
A systematic literature search was performed using PubMed, Embase, the Cochrane Library, Web of Science, VIP, Chinese National Knowledge Infrastructure, and Wan Fang databases from initiation to January 30, 2021. A Bayesian network meta-analysis was performed using ADDIS (Aggregate Data Drug Information System) software. The PROSPERO registration number was CRD42020129635.
We included 12 studies with 642 patients in the present study. A network meta-analysis revealed that bone mesenchymal stem cells (BMSCs) combined with rehabilitation training were significantly more effective than rehabilitation training alone in improving the American Spinal Injury Association (ASIA) impairment scale grade (odds ratio, 94.25; 95% confidence interval [CI], 6.71-9321.95), ASIA motor score (weighted mean difference [WMD], 6.67; 95% CI, 0.83-12.73), ASIA sensory functional score (WMD, 12.41; 95% CI, 3.42-21.72), and Barthel index (WMD, 7.24; 95% CI, 0.21-14.30). However, no statistically significant differences were observed between bone marrow mononuclear cells (MNCs) combined with rehabilitation training, umbilical cord-derived mesenchymal stem cells (UCMSCs) combined with rehabilitation training, or UCMSCs alone and rehabilitation alone for all indicators. In terms of safety, there were no serious and permanent adverse effects after transplantation of BMSCs, MNCs, or UCMSCs.
BMSCs plus rehabilitation might be superior to other stem cell treatments of SCI in improving the ASIA impairment scale grade, ASIA motor score, ASIA sensory functional score, and Barthel index. The therapeutic effects of UCMSCs and MNCs remain to be confirmed.
在本研究中，我们评估了不同类型干细胞用于脊髓损伤（SCI）治疗的疗效和安全性，以确定SCI的最佳治疗方法。
使用PubMed、Embase、Cochrane图书馆、Web of Science、维普、中国知网和万方数据库，从建库至2021年1月30日进行系统的文献检索。使用ADDIS（汇总数据药物信息系统）软件进行贝叶斯网络荟萃分析。PROSPERO注册号为CRD42020129635。
本研究纳入了12项研究，共642例患者。网络荟萃分析显示，骨髓间充质干细胞（BMSCs）联合康复训练在改善美国脊髓损伤协会（ASIA）损伤分级量表等级（优势比，94.25；95%置信区间[CI]，6.71 - 9321.95）、ASIA运动评分（加权均数差[WMD]，6.67；95%CI，0.83 - 12.73）、ASIA感觉功能评分（WMD，12.41；95%CI，3.42 - 21.72）和Barthel指数（WMD，7.24；95%CI，0.21 - 14.30）方面明显优于单纯康复训练。然而，对于所有指标，在骨髓单个核细胞（MNCs）联合康复训练、脐带间充质干细胞（UCMSCs）联合康复训练、单独使用UCMSCs或单独康复训练之间未观察到统计学上的显著差异。在安全性方面，BMSCs、MNCs或UCMSCs移植后没有严重和永久性的不良反应。
在改善ASIA损伤分级量表等级、ASIA运动评分、ASIA感觉功能评分和Barthel指数方面，BMSCs加康复治疗可能优于其他SCI干细胞治疗方法。UCMSCs和MNCs的治疗效果仍有待证实。
