Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
West China Brain Research Centre, Sichuan University, Chengdu, Sichuan, 610041, PR China.
Curr Stem Cell Res Ther. 2024;19(8):1102-1110. doi: 10.2174/1574888X18666230823094531.
Several types of stem cells are available for the treatment of stroke patients. However, the optimal type of stem cell remains unclear.
To analyze the effects of bone marrow-derived stem cell therapy in patients with ischemic stroke by integrating all available direct and indirect evidence in network meta-analyses.
We searched several databases to identify randomized clinical trials comparing clinical outcomes of bone marrow-derived stem cell therapy . conventional treatment in stroke patients. Pooled relative risks (RRs) and mean differences (MDs) were reported. The surface under the cumulative ranking (SUCRA) was used to rank the probabilities of each agent regarding different outcomes.
Overall, 11 trials with 576 patients were eligible for analysis. Three different therapies, including mesenchymal stem cells (MSCs), mononuclear stem cells (MNCs), and multipotent adult progenitor cells (MAPCs), were assessed. The direct analysis demonstrated that stem cell therapy was associated with significantly reduced all-cause mortality rates (RR 0.55, 95% CI 0.33 to 0.93; I=0%). Network analysis demonstrated MSCs ranked first in reducing mortality (RR 0.42, 95% CrI 0.15 to 0.86) and improving modified Rankin Scale score (MD -0.59 95% CI -1.09 to -0.09), with SUCRA values 80%, and 98%, respectively. Subgroup analysis showed intravenous transplantation was superior to conventional therapy in reducing all-cause mortality (RR 0.53, 95% CrI 0.29 to 0.88).
Using stem cell transplantation was associated with reduced risk of death and improved functional outcomes in patients with ischemic stroke. Additional large trials are warranted to provide more conclusive evidence.
有几种类型的干细胞可用于治疗中风患者。然而，最佳的干细胞类型仍不清楚。
通过整合网络荟萃分析中的所有可用直接和间接证据，分析骨髓源性干细胞治疗缺血性中风患者的效果。
我们搜索了几个数据库，以确定比较骨髓源性干细胞治疗与常规治疗中风患者的临床结局的随机临床试验。报告了合并的相对风险（RR）和平均差异（MD）。使用累积排序概率曲线下面积（SUCRA）来对每种药物在不同结局中的概率进行排名。
共有 11 项试验，涉及 576 名患者，符合分析条件。评估了三种不同的治疗方法，包括间充质干细胞（MSCs）、单核细胞干细胞（MNCs）和多能成体祖细胞（MAPCs）。直接分析表明，干细胞治疗与全因死亡率显著降低相关（RR 0.55，95% CI 0.33 至 0.93；I=0%）。网络分析表明，MSCs 在降低死亡率方面排名第一（RR 0.42，95% CrI 0.15 至 0.86），并改善改良 Rankin 量表评分（MD-0.59，95% CI-1.09 至-0.09），SUCRA 值分别为 80%和 98%。亚组分析表明，静脉移植在降低全因死亡率方面优于常规治疗（RR 0.53，95% CrI 0.29 至 0.88）。
使用干细胞移植与降低缺血性中风患者的死亡风险和改善功能结局相关。需要进一步的大型试验来提供更具结论性的证据。
