Adult bone marrow cell therapy improves survival and induces long-term improvement in cardiac parameters: a systematic review and meta-analysis.
Adult bone marrow cell therapy improves survival and induces long-term improvement in cardiac parameters: a systematic review and meta-analysis.
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DOI：
10.1161/circulationaha.111.086074
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发表时间：
2012-07-31
期刊：
影响因子：
37.8
通讯作者：
Dawn B
中科院分区：
文献类型：
--
作者：
Jeevanantham V;Butler M;Saad A;Abdel-Latif A;Zuba-Surma EK;Dawn B
尽管临床转化迅速且受到广泛关注，但成人骨髓细胞（BMC）移植对缺血性心脏病（IHD）患者的治疗效果仍然存在争议。现有数据的综合对于理解和强调这种有希望的方法的真正影响至关重要。截至 2012 年 1 月，共有 50 项研究（纳入 2,625 名患者）通过数据库检索确定。使用随机效应荟萃分析估计左心室（LV）射血分数（LVEF）、梗死面积、左心室收缩末期容积（LVESV）和左心室舒张末期容积（LVEDV）变化的加权平均差异。与对照组相比，BMC 治疗患者的 LVEF 更大（3.96%，95% 置信区间 (CI)：2.90、5.02；P<0.00001），梗塞面积更小（–4.03%，CI：–5.47，–2.59；P<0.00001），LVESV（–8.91 ml，CI：–11.57， –6.25；P<0.00001) 和 LVEDV (–5.23 ml，CI：–7.60，–2.86；P<0.0001)。无论研究设计（随机对照试验与队列研究）和 IHD 类型（急性心肌梗死与慢性 IHD）如何，这些益处均得到体现，并且在长期随访期间持续存在。重要的是，与对照组相比，BMC 治疗患者的全因死亡率、心脏死亡率以及复发性心肌梗死和支架血栓形成的发生率显着降低。与标准治疗相比，成人 BMC 移植可改善 IHD 患者的左心室功能、梗塞面积和重塑，并且这些益处在长期随访中持续存在。 BMC 移植还可以降低 IHD 患者的死亡、复发性心肌梗死和支架内血栓形成的发生率。
Despite rapid clinical translation and widespread enthusiasm, the therapeutic benefits of adult bone marrow cell (BMC) transplantation in patients with ischemic heart disease (IHD) continue to remain controversial. A synthesis of the available data is critical to appreciate and underscore the true impact of this promising approach. A total of 50 studies (enrolling 2,625 patients) identified by database searches through January 2012 were included. Weighted Mean Differences for changes in left ventricular (LV) ejection fraction (LVEF), infarct size, LV end-systolic volume (LVESV), and LV end-diastolic volume (LVEDV) were estimated using random effects meta-analysis. Compared with controls, BMC-treated patients exhibited greater LVEF (3.96%, 95% confidence interval (CI): 2.90, 5.02; P<0.00001), and smaller infarct size (–4.03%, CI: –5.47, –2.59; P<0.00001), LVESV (–8.91 ml, CI: –11.57, –6.25; P<0.00001), and LVEDV (–5.23 ml, CI: – 7.60, –2.86; P<0.0001). These benefits were noted irrespective of the study design (RCT vs. Cohort study) and the type of IHD (acute myocardial infarction vs. chronic IHD), and persisted during long-term follow-up. Importantly, the all-cause mortality, cardiac mortality, and the incidence of recurrent MI and stent thrombosis were significantly lower in BMC-treated patients compared with controls. Transplantation of adult BMCs improves LV function, infarct size, and remodeling in patients with IHD compared with standard therapy, and these benefits persist during long-term follow-up. BMC transplantation also reduces the incidence of death, recurrent MI, and stent thrombosis in patients with IHD.