Efficacy of mesenchymal stem cells in treating patients with osteoarthritis of the knee: A meta-analysis
Efficacy of mesenchymal stem cells in treating patients with osteoarthritis of the knee: A meta-analysis
复制标题
间充质干细胞治疗膝骨关节炎患者的功效：荟萃分析。
DOI：
10.3892/etm.2016.3791
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发表时间：
2016-11-01
影响因子：
2.7
通讯作者：
Wang, Wei-Shan
中科院分区：
文献类型：
--
作者：
Cui, Gang-Hua;Wang, Yang Yang;Wang, Wei-Shan
为评估间充质干细胞（MSC）治疗膝骨关节炎（KOA）的临床疗效与安全性，我们在PubMed、EMBASE和Web of Science数据库中进行了系统的电子文献检索。检索使用了以下关键词，搜索自最早记录至2014年12月期间发表的英文研究：软骨缺损、软骨修复、骨关节炎、膝骨关节炎、干细胞、间充质干细胞、骨髓浓缩物（BMC）、脂肪来源的间充质干细胞、滑膜来源的间充质干细胞以及外周血来源的间充质干细胞。通过提取视觉模拟量表中的疼痛评分，以及国际膝关节文献委员会、Lysholm评分和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）中关于MSC或对照治疗前后3个月、6个月、12个月及24个月的功能变化，来确定所选研究的效应量。在将MSC组汇总值与治疗前基线进行比较，或在不同治疗组间进行比较后，对相关因素进行分析并修正结果。一项系统检索共确定了18项关于该主题的临床试验，其中包括10项单臂前瞻性研究、4项准实验研究以及4项随机对照试验，这些研究共使用BMC治疗了565例KOA患者。与治疗前状况相比，MSC治疗KOA患者在24个月内显示出持续疗效。与治疗后3个月和6个月相比，治疗后12个月和24个月时MSC的疗效有所提高。未发现MSC数量与疗效存在剂量反应关系。然而，接受关节镜清创术、使用激活剂或Kellgren - Lawrence分级较低的患者取得了更好的治疗效果。MSC的应用改善了KOA患者的总体治疗效果，包括从基础评估来看，疼痛得到缓解且功能有所改善，尤其是在随访12个月和24个月时。
To assess the clinical efficacy and safety of mesenchymal stem cell (MSC) treatment for osteoarthritis of the knee (KOA), a systematic electronic literature search was performed on PubMed, EMBASE and Web of Science. Studies published in English from the earliest record to December 2014 were searched using the following keywords: Cartilage defect, cartilage repair, osteoarthritis, KOA, stem cells, MSCs, bone marrow concentrate (BMC), adipose-derived mesenchymal stem cells, synovial-derived mesenchymal stem cells and peripheral blood-derived mesenchymal stem cells. The effect sizes of selected studies were determined by extracting pain scores from the visual analog scale and functional changes from International Knee Documentation Committee and Lysholm and Western Ontario and McMaster Universities Osteoarthritis Index before and after MSCs or reference treatments at 3, 6, 12, and 24 months. The factors were analyzed and the outcomes were modified after comparing the MSC group pooled values with the pretreatment baseline or between different treatment arms. A systematic search identified 18 clinical trials on this topic, including 10 single-arm prospective studies, four quasi-experimental studies and four randomized controlled trials that used BMCs to treat 565 patients with KOA in total. MSC treatment in patients with KOA showed continual efficacy for 24 months compared with their pretreatment condition. Effectiveness of MSCs was improved at 12 and 24 months post-treatment, compared with at 3 and 6 months. No dose-responsive association in the MSCs numbers was demonstrated. However, patients with arthroscopic debridement, activation agent or lower degrees of Kellgren-Lawrence grade achieved improved outcomes. MSC application ameliorated the overall outcomes of patients with KOA, including pain relief and functional improvement from basal evaluations, particularly at 12 and 24 months after follow-up.