干细胞负载支架促进子宫内膜再生和恢复生育能力的有效性：系统评价和荟萃分析。
Validity of stem cell-loaded scaffolds to facilitate endometrial regeneration and restore fertility: a systematic review and meta-analysis.
机构信息
Department of Gynaecology and Obstetrics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
出版信息
Front Endocrinol (Lausanne). 2024 May 23;15:1397783. doi: 10.3389/fendo.2024.1397783. eCollection 2024.
OBJECTIVE
Various stem cell-loaded scaffolds have demonstrated promising endometrial regeneration and fertility restoration. This study aimed to evaluate the efficacy of stem cell-loaded scaffolds in treating uterine injury in animal models.
METHODS
The PubMed, Embase, Scopus, and Web of Science databases were systematically searched. Data were extracted and analyzed using Review Manager version 5.4. Improvements in endometrial thickness, endometrial glands, fibrotic area, and number of gestational sacs/implanted embryos were compared after transplantation in the stem cell-loaded scaffolds and scaffold-only group. The standardized mean difference (SMD) and confidence interval (CI) were calculated using forest plots.
RESULTS
Thirteen studies qualified for meta-analysis. Overall, compared to the scaffold groups, stem cell-loaded scaffolds significantly increased endometrial thickness (SMD = 1.99, 95% CI: 1.54 to 2.44, P < 0.00001; I² = 16%) and the number of endometrial glands (SMD = 1.93, 95% CI: 1.45 to 2.41, P < 0.00001; I² = 0). Moreover, stem cell-loaded scaffolds present a prominent effect on improving fibrosis area (SMD = -2.50, 95% CI: -3.07 to -1.93, P < 0.00001; I² = 36%) and fertility (SMD = 3.34, 95% CI: 1.58 to 5.09, P = 0.0002; I² = 83%). Significant heterogeneity among studies was observed, and further subgroup and sensitivity analyses identified the source of heterogeneity. Moreover, stem cell-loaded scaffolds exhibited lower inflammation levels and higher angiogenesis, and cell proliferation after transplantation.
CONCLUSION
The evidence indicates that stem cell-loaded scaffolds were more effective in promoting endometrial repair and restoring fertility than the scaffold-only groups. The limitations of the small sample sizes should be considered when interpreting the results. Thus, larger animal studies and clinical trials are needed for further investigation.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024493132.
目的
各种干细胞负载支架已显示出有希望的子宫内膜再生和生育力恢复。本研究旨在评估干细胞负载支架在动物模型中治疗子宫损伤的疗效。
方法
系统检索了 PubMed、Embase、Scopus 和 Web of Science 数据库。使用 Review Manager 版本 5.4 提取和分析数据。比较干细胞负载支架组和支架组移植后子宫内膜厚度、子宫内膜腺体、纤维化面积和妊娠囊/植入胚胎数量的改善情况。使用森林图计算标准化均数差（SMD）和置信区间（CI）。
结果
13 项研究符合荟萃分析条件。总体而言，与支架组相比，干细胞负载支架可显著增加子宫内膜厚度（SMD=1.99，95%CI：1.54 至 2.44，P<0.00001；I²=16%）和子宫内膜腺体数量（SMD=1.93，95%CI：1.45 至 2.41，P<0.00001；I²=0）。此外，干细胞负载支架对改善纤维化面积（SMD=-2.50，95%CI：-3.07 至-1.93，P<0.00001；I²=36%）和生育力（SMD=3.34，95%CI：1.58 至 5.09，P=0.0002；I²=83%）具有显著效果。研究间存在显著异质性，进一步的亚组和敏感性分析确定了异质性的来源。此外，干细胞负载支架在移植后表现出较低的炎症水平和较高的血管生成和细胞增殖。
结论
证据表明，与支架组相比，干细胞负载支架在促进子宫内膜修复和恢复生育力方面更有效。在解释结果时，应考虑到样本量小的局限性。因此，需要进行更大的动物研究和临床试验以进一步研究。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO，标识符 CRD42024493132。
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