肛瘘干细胞治疗疗效与安全性的系统评价和荟萃分析

Systematic review and meta-analysis of the efficacy and safety of stem cell treatment of anal fistulas.

作者信息

Emile S H, Dourado J, Rogers P, Wignakumar A, Horesh N, Garoufalia Z, Wexner S D

机构信息

Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.

Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.

出版信息

Tech Coloproctol. 2025 Apr 9;29(1):100. doi: 10.1007/s10151-025-03138-y.

DOI:10.1007/s10151-025-03138-y

PMID:40205247

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11982159/

Abstract

BACKGROUND

Since anal fistulas can be challenging to treat; numerous innovative treatments have been proposed, including stem cell therapy. This systematic review aimed to assess pooled rates of fistula healing and adverse events associated with stem cell treatment.

METHODS

In this PRISMA-compliant systematic review we searched PubMed and Scopus for observational and randomized studies reporting outcomes of stem cell treatment for anal fistulas. The main outcome measures were successful healing and adverse effects of stem cell therapy.

RESULTS

In total, 43 studies incorporating 1160 patients (53.6% male) were included. Underlying fistula etiologies were Crohn's disease (30 studies) and cryptoglandular disease (12 studies). The main origin of stem cells was from adipose tissue (34 studies) or bone marrow (6 studies). The median follow-up duration was 12 months. The combined overall pooled healing rate was 58.1% (95% confidence interval (CI) 51.5-64.7%). The pooled healing rate for Crohn's fistulas was 60.4% (95% CI 54.7-66.2%) with adipose-derived stem cells and 63.6% (95% CI 49.4-77.7%) with bone-marrow-derived cells. The pooled healing rate for cryptoglandular fistulas was 53.8% (95% CI 35.5-72.2%) with adipose-derived stem cells. The pooled complication rate was 37.3% (95% CI 27.1-47.5%). Stem cells were associated with higher odds of anal fistula healing (odds ratio (OR): 1.81, p = 0.003) and similar odds of complications (OR: 1, p = 0.986) compared with controls.

CONCLUSIONS

Stem cell treatment of anal fistulas was associated with promising results. The healing rate in Crohn's anal fistulas was higher than in cryptoglandular fistulas. Bone-marrow-derived stem cells were associated with marginally better outcomes than were adipose-derived cells. This finding suggests that the autoimmune inflammatory etiology of Crohn's disease may respond better to autologous myoblasts than does the infectious etiology of cryptoglandular fistulas.

摘要

背景

由于肛瘘的治疗颇具挑战性，因此人们提出了许多创新疗法，包括干细胞疗法。本系统评价旨在评估干细胞治疗肛瘘的愈合率及不良事件的汇总发生率。

方法

在这项符合PRISMA标准的系统评价中，我们检索了PubMed和Scopus数据库，以查找报告干细胞治疗肛瘘结果的观察性研究和随机对照研究。主要结局指标为干细胞治疗的成功愈合情况及不良反应。

结果

共纳入43项研究，涉及1160例患者（男性占53.6%）。肛瘘的潜在病因包括克罗恩病（30项研究）和隐窝腺源性疾病（12项研究）。干细胞的主要来源是脂肪组织（34项研究）或骨髓（6项研究）。中位随访时间为12个月。综合总体愈合率为58.1%（95%置信区间[CI] 51.5 - 64.7%）。克罗恩病肛瘘使用脂肪来源干细胞的愈合率为60.4%（95% CI 54.7 - 66.2%），使用骨髓来源干细胞的愈合率为63.6%（95% CI 49.4 - 77.7%）。隐窝腺源性肛瘘使用脂肪来源干细胞的愈合率为53.8%（95% CI 35.5 - 72.2%）。汇总并发症发生率为37.3%（95% CI 27.1 - 47.5%）。与对照组相比，干细胞治疗肛瘘愈合的可能性更高（优势比[OR]：1.81，p = 0.003），并发症发生的可能性相似（OR：1，p = 0.986）。