Objective: To achieve the systematical review and Meta-analysis of the efficacy and safety of stem cell transplantation therapies in patients with ischemic stroke. Methods: We searched Cochrane Library, PubMed, Ovid, CBM, CNKI, WanFang and VIP Data from its inception to December 2015, to collect randomized controlled trials(RCT) of stem cell transplantation therapies for ischemic stroke. Two authors independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias. Then, Meta-analysis was performed by RevMan 5.3 software. Results: Sixteen studies and eighteen independent studies were included in the Meta-analysis. The results of pooled mean difference from baseline to follow-up points showed that the stem cell transplantation group was superior to the control group with statistical significance in the neurologic deficits score(NIHSS, MD=1. 57, 95%CI 0.64-2.51, I2=57%, P=0.001), motor function(FMA, MD=4.23, 95%CI 3.08-5.38, I2=0%, P<0.000 01), daily life ability(Barthel, MD=8.37, 95%CI 4.83-11.91, I2=63%, P<0.000 01), and functional independence(FIM, MD=8.89, 95%CI 4.70-13.08, I2=79%, P<0.000 1). Conclusion: The published literatures suggest that the stem cell transplantation therapies for patients with ischemic stroke can improve the neurological deficits and the daily life quality, with no serious adverse events. However, more studies with high-quality and larger data are needed to further investigate the clinical efficacy of the stem cell transplantation. |
[1] NAGHAVI M,WANG H,LOZANO R,et al.Global,regional,and national age-sex specific all-cause and cause-specific mortality for 240 causes of death,1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[J].Lancet,2015,385(9963):117-171.
[2] BRATTLIE J,XIEC J,BELDING E.Modern drug discovery from Chinese materia medica used in[J].Traditional Chinese Medicine:Scientific Basis for Its Use,2013(31):81.
[3] WANG C,LI J,ZHAO X,et al.Stroke care development in Mainland China:past,present and future[J].Int J Stroke,2008,3(4):288-289.
[4] NING M,SARRACINO D A,BUONANNO F S,et al.Proteomic protease substrate profiling of tPA treatment in acute ischemic stroke patients:a step toward individualizing thrombolytic therapy at the bedside[J].Transl Stroke Res,2010,1(4):268-275.
[5] CRAMER S C,STRADLING D,BROWN D M,et al.Organization of a United States county system for comprehensive acute stroke care[J].Stroke,2012,43(4):1089-1093.
[6] CRAMER S C.Repairing the human brain after stroke.Ⅱ.Restorative therapies[J].Ann Neurol,2008,63(5):549-560.
[7] LEE M C,JIN C Y,KIM H S,et al.Stem cell dynamics in an experimental model of stroke[J].Chonnam Med J,2011,47(2):90-98.
[8] DAADI M M.In vitro assays for neural stem cell differentiation[J].Methods Mol Biol,2002,198:149-155.
[9] MARTINO G,PLUCHINO S.The therapeutic potential of neural stem cells[J].Nat Rev Neurosci,2006,7(5):395-406.
[10] BANG O Y,LEE J S,LEE P H,et al.Autologous mesenchymal stem cell transplantation in stroke patients[J].Annals of Neurology,2005,57(6):874-882.
[11] 孙洪波,夏圣梅,杨姗杉,等.G-CSF联合自体骨髓间充质干细胞移植治疗急性脑梗死的临床研究[J].中国医师杂志,2008,10(4):441-443.
[12] 牛光清,郭镔荣,常晓燕,等.神经干细胞移植治疗脑梗死后遗症临床分析[J].中国医药,2010,5(7):615-616.
[13] BHASIN A,SRIVASTAVA M V,KUMARAN S S,et al.Autologous mesenchymal stem cells in chronic stroke[J].Cerebrovasc Dis Extra,2011,1(1):93-104.
[14] 邓英光,张紫萍,余卫.丹参注射液联合骨髓干细胞移植治疗脑梗死肢体瘫痪的临床研究[J].实用心脑肺血管病杂志,2012,20(3):424-425.
[15] 何振东.骨髓间充质干细胞移植改善脑梗死患者神经功能机制研究[J].亚太传统医药,2012,8(12):126-127.
[16] BHASIN A,SRIVASTAVA M V,BHATIA R,et al.Autologous intravenous mononuclear stem cell therapy in chronic ischemic stroke[J].J Stem Cells Regen Med,2012,8(3):181-189.
[17] 肖兴花.干细胞移植治疗脑梗死78例临床观察[J].山东医药,2013,53(9):52-53.
[18] BHASIN A,SRIVASTAVA M V,MOHANTY S,et al.Stem cell therapy:A clinical trial of stroke[J].Clinical Neurology and Neurosurgery,2013,115(7):1003-1008.
[19] 刘定华,韩伯军,洪珊珊,等.自体骨髓间充质神经干细胞移植治疗脑梗死的疗效观察[J].中华物理医学与康复杂志,2014,36(6):425-428.
[20] 谢旭芳,刘诗英,金光华,等.自体骨髓间充质干细胞移植治疗脑梗死的临床分析[J].检验医学与临床,2014(21):2955-2957.
[21] CHEN D C,LIN S Z,FAN J R,et al.Intracerebral implantation of autologous peripheral blood stem cells in stroke patients:a randomized phase Ⅱ study[J].Cell Transplantation,2014,23(12):1599-1612.
[22] PRASAD K,SHARMA A,GARG A,et al.Intravenous autologous bone marrow mononuclear stem cell therapy for ischemic stroke:a multicentric,randomized trial[J].Stroke,2014,45(12):3618-3624.
[23] 张敏,吴世陶,刘磊,等.神经干细胞移植治疗脑梗死的临床观察[J].中国实用神经疾病杂志,2015(22):8-10.
[24] 沈大鹏.脐带间充质干细胞早期单次移植治疗对急性脑梗死的神经功能恢复[J].中国伤残医学,2015(2):26-28.
[25] 蔡谋善,沈春林,曾令海,等.干细胞移植对缺血性脑卒中患者血清同型半胱氨酸、CRP及BDNF含量影响研究[J].中国生化药物杂志,2015(9):91-93.
[26] 冯书贤,程坚.造血干细胞移植后的神经系统并发症及诊治进展[J].东南大学学报:医学版,2015,34(2):285-290.
[27] 陆文青,吴小涛,洪鑫.间充质干细胞移植对椎间盘退变修复作用的研究进展[J].东南大学学报:医学版,2012,31(3):331-333.
[28] LEES J S,SENA E S,EGAN K J,et al.Stem cell-based therapy for experimental stroke:a systematic review and meta-analysis[J].Int J Stroke,2012,7(7):582-588.
[29] VU Q,XIE K,ECKERT M,et al.Meta-analysis of preclinical studies of mesenchymal stromal cells for ischemic stroke[J].Neurology,2014,82(14):1277-1286.
[30] 刘超,吴海琴,严璞,等.骨髓间充质干细胞移植治疗缺血性脑卒中疗效和安全性的Meta分析[J].中国循证医学杂志,2015,15(6):659-663.
[31] JEONG H,YIM H W,CHO Y S,et al.Efficacy and safety of stem cell therapies for patients with stroke:a systematic review and single arm meta-analysis[J].Int J Stem Cells,2014,7(2):63-69. |