基于再生医学的间充质干细胞治疗压力性尿失禁：系统评价与荟萃分析

Regenerative Medicine-Based Treatment of Stress Urinary Incontinence with Mesenchymal Stem Cells: A Systematic Review and Meta-analysis.

作者信息

Mariotti Gianna, Salciccia Stefano, Viscuso Pietro, Bevilacqua Giulio, Casale Paolo, Frisenda Marco, Di Pierro Giovanni Battista, Cattarino Susanna, Gentilucci Alessandro, Rosati Davide, Sciarra Beatrice, Sciarra Alessandro

机构信息

Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy.

Department of Urology, Humanitas Clinical and Research Center IRCCS, Humanitas, Milan, Italy.

出版信息

Curr Stem Cell Res Ther. 2023;18(3):429-437. doi: 10.2174/1574888X17666220616100621.

DOI:10.2174/1574888X17666220616100621

PMID:35713128

Abstract

OBJECTIVES

The aim of this systematic review and meta-analysis is to analyze clinical trials on the use of autologous stem cell [SC] injection for the treatment of stress urinary incontinence [SUI] in humans.

METHODS

We analyzed the effect in terms of UI improvement and continence recovery after treatment. A literature search was performed following the PRISMA guidelines. Entry into the analysis was restricted to data collected from clinical prospective trials on humans, including female and male patients with SUI. We performed a cumulative meta-analysis to explore the trend in the effect size across different groups at follow-up. Available data were compared in terms of Event Rate [ER] for the percentage of pad-free patients.

RESULTS

12 trials were enclosed in the analysis. The sample size of patients with SUI ranged from 5 to 123 cases, mainly female cases. Autologous muscle-derived stem cells [MDSCs] were used in 9 and adipocyte- derived SCs [ADSC] in 3 trials. Considering a random effect model, ER of continence recovery was 0.41 [95%CI 0.29 - 0.54], with similar results between the ADSC [ER, 0.40;95%CI 0.12 - 0.69] and the MDSC group [ER 0.41; 95%CI 0.27-0.55] [I2 84.69%; Q 104.69 - p<0.01] [Test of group differences p=0.96].

CONCLUSION

Autologous MDSC or ADSC injection to treat SUI is demonstrated to be a safe procedure and a 41% mean rate of continence recovery is described. A higher effort should be produced to design better clinical trials, objectively evaluating either modifications inside the urethral sphincter or long-term functional results in terms of pad test and UI questionnaires.

摘要

目的

本系统评价和荟萃分析旨在分析自体干细胞注射治疗人类压力性尿失禁（SUI）的临床试验。

方法

我们从治疗后尿失禁改善和控尿恢复方面分析效果。按照PRISMA指南进行文献检索。纳入分析的数据仅限于从人类临床前瞻性试验收集的数据，包括患有SUI的女性和男性患者。我们进行累积荟萃分析以探索随访时不同组效应大小的趋势。根据无尿垫患者百分比的事件发生率（ER）比较可用数据。

结果

12项试验纳入分析。SUI患者样本量为5至123例，主要为女性病例。9项试验使用自体肌肉来源干细胞（MDSCs），3项试验使用脂肪来源干细胞（ADSCs）。考虑随机效应模型，控尿恢复的ER为0.41（95%CI 0.29 - 0.54），ADSC组（ER，0.40；95%CI 0.12 - 0.69）和MDSC组（ER 0.41；95%CI 0.27 - 0.55）结果相似（I² 84.69%；Q 104.69 - p<0.01）（组间差异检验p = 0.96）。