Mesenchymal Stem Cells Injection Is More Effective Than Hyaluronic Acid Injection in the Treatment of Knee Osteoarthritis With Similar Safety: A Systematic Review and Meta-Analysis.
Wen-Shu Jin, Lu-Xu Yin, Hua-Qiang Sun, Zhang Zhao, Xin-Feng Yan
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引用次数: 0
Abstract
Purpose: To evaluate the efficacy and safety of intra-articular injection of mesenchymal stem cells (MSCs) versus hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA).
Methods: Eligible randomized controlled trials (RCTs) were identified through a search of PubMed, Embase, the Cochrane Library, Web of Science, SinoMed, and CNKI databases from inception to March 2024. For meta-analysis, data on clinical outcomes were measured using visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); data on safety were evaluated by the incidence of adverse events. Two researchers independently read the included literature, extracted data and evaluated the quality, used the Cochrane risk bias assessment tool for bias risk assessment, and used RevMan5.3 software for meta-analysis.
Results: Ten RCTs involving 818 patients with KOA ranging from I to Ⅲ on the Kellgren-Lawrence grading scale were included in this meta-analysis. Meta-analysis results showed that at 12 months, the WOMAC total score (mean difference [MD] = -10.22, 95% confidence interval [CI]: -14.86 to -5.59, P < .0001, Z = 4.32), VAS score (MD = -1.31, 95% CI: -1.90 to -0.73, P < .0001, Z = 4.40); and WORMS score (MD = -26.01, 95% CI: -31.88 to -20.14, P < .001, Z = 8.69) of the MSCs group all decreased significantly (P < .05) compared with the HA control group and reached the minimal clinically important differences. Furthermore, there was no significant difference in the incidence of adverse events (relative risk = 1.54, 95% CI: 0.85-2.79, P = .16, I2 = 0) between the 2 groups (P > .05).
Conclusions: Compared with HA, intra-articular injection of MSCs therapy appears to alleviate joint pain effectively, improving clinical function of KOA patients. These benefits are observed to last for at least 12 months without an increase in adverse events. Due to limited, varied, and lacking minimal clinically important differences results in existing literature, further research is needed.
Level of evidence: Level I, meta-analysis of Level I studies.
目的：评估关节内注射间充质干细胞（MSCs）与透明质酸（HA）治疗膝骨关节炎（KOA）的有效性和安全性：方法：通过检索Pubmed、Embase、Cochrane图书馆、Web of science、SinoMed和CNKI数据库（从开始到2024年3月），确定符合条件的随机对照试验（RCT）。在进行荟萃分析时，临床结果数据采用视觉模拟量表（VAS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）进行测量，软骨修复数据采用全器官磁共振成像评分（WORMS）进行测量；安全性数据通过不良事件发生率进行评估。两名研究人员独立阅读纳入文献，提取数据并评估质量，使用Cochrane风险偏倚评估工具进行偏倚风险评估，并使用RevMan5.3软件进行Meta分析：本次荟萃分析共纳入10项研究，涉及818例KOA患者，Kellgren-Lawrence分级为I-Ⅲ级。Meta结果显示，与HA对照组相比，两组患者在12个月时的WOMAC总分 ［MD=-10.22，95% CI（-14.86∼-5.59），P2=0］差异无统计学意义（P>0.05）：结论：与 HA 相比，关节内注射间充质干细胞疗法似乎能有效缓解 KOA 患者的关节疼痛，改善其临床功能。结论：与 HA 相比，关节内注射间充质干细胞疗法似乎能有效缓解关节疼痛，改善 KOA 患者的临床功能，这些益处至少能持续 12 个月，且不会增加不良反应。由于现有文献中的研究结果有限、多样且缺乏MCID，因此需要进一步研究：一级，一级研究的元分析。
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Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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