{"title":"间充质干细胞疗法治疗缺血性中风的有效性和安全性：系统回顾和荟萃分析。","authors":"Zhiyuan Shen, Xian Tang, Yaxin Zhang, Yicun Jia, Xin Guo, Xiaosu Guo, Junqiang Bao, Xiongwei Xie, Yuan Xing, Jun Xing, Shujuan Tian","doi":"10.1093/stcltm/szae040","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The efficacy and safety of mesenchymal stem cells (MSCs) in the treatment of ischemic stroke (IS) remains controversial. Therefore, this study aimed to evaluate the efficacy and safety of MSCs for IS.</p><p><strong>Methods: </strong>A literature search until May 23, 2023, was conducted using PubMed, EMBASE, the Cochrane Library, and the Web of Science to identify studies on stem cell therapy for IS. Interventional and observational clinical studies of MSCs in patients with IS were included, and the safety and efficacy were assessed. Two reviewers extracted data and assessed the quality independently. The meta-analysis was performed using RevMan5.4.</p><p><strong>Results: </strong>Fifteen randomized controlled trials (RCTs) and 15 non-randomized trials, including 1217 patients (624 and 593 in the intervention and control arms, respectively), were analyzed. MSCs significantly improved patients' activities of daily living according to the modified Rankin scale (mean difference [MD]: -0.26; 95% confidence interval [CI]: -0.50 to -0.01; P = .04) and National Institutes of Health Stroke Scale score (MD: -1.69; 95% CI: -2.66 to -0.73; P < .001) in RCTs. MSC treatment was associated with lower mortality rates in RCTs (risk ratio: 0.44; 95% CI: 0.28-0.69; P < .001). Fever and headache were among the most reported adverse effects.</p><p><strong>Conclusions: </strong>Based on our review, MSC transplantation improves neurological deficits and daily activities in patients with IS. In the future, prospective studies with large sample sizes are needed for stem cell studies in ischemic stroke. 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引用次数: 0
摘要
背景：间充质干细胞（MSCs）治疗缺血性中风（IS）的有效性和安全性仍存在争议。因此，本研究旨在评估间充质干细胞治疗缺血性中风的有效性和安全性：方法：使用PubMed、EMBASE、Cochrane图书馆和Web of Science对截至2023年5月23日的文献进行检索，以确定有关干细胞治疗IS的研究。研究纳入了间充质干细胞治疗IS患者的干预性和观察性临床研究，并对其安全性和有效性进行了评估。两名审稿人独立提取数据并评估质量。荟萃分析采用RevMan5.4进行：结果：共分析了15项随机对照试验（RCT）和15项非随机试验，包括1217名患者（干预组和对照组分别为624人和593人）。根据改良Rankin量表，间充质干细胞能明显改善患者的日常生活能力（平均差[MD]：-0.26；95%置信区间[CI]：-0.50至-0.01；P = .04）和美国国立卫生研究院卒中量表评分（MD：-1.69；95% CI：-2.66至-0.73；P 结论：间充质干细胞移植能改善患者的日常生活能力：根据我们的综述，间充质干细胞移植可改善IS患者的神经功能缺损和日常活动能力。未来，缺血性中风干细胞研究需要大样本量的前瞻性研究。本荟萃分析已在 PROSPERO 注册，注册号为 CRD42022347156。
Efficacy and safety of mesenchymal stem cell therapies for ischemic stroke: a systematic review and meta-analysis.
Background: The efficacy and safety of mesenchymal stem cells (MSCs) in the treatment of ischemic stroke (IS) remains controversial. Therefore, this study aimed to evaluate the efficacy and safety of MSCs for IS.
Methods: A literature search until May 23, 2023, was conducted using PubMed, EMBASE, the Cochrane Library, and the Web of Science to identify studies on stem cell therapy for IS. Interventional and observational clinical studies of MSCs in patients with IS were included, and the safety and efficacy were assessed. Two reviewers extracted data and assessed the quality independently. The meta-analysis was performed using RevMan5.4.
Results: Fifteen randomized controlled trials (RCTs) and 15 non-randomized trials, including 1217 patients (624 and 593 in the intervention and control arms, respectively), were analyzed. MSCs significantly improved patients' activities of daily living according to the modified Rankin scale (mean difference [MD]: -0.26; 95% confidence interval [CI]: -0.50 to -0.01; P = .04) and National Institutes of Health Stroke Scale score (MD: -1.69; 95% CI: -2.66 to -0.73; P < .001) in RCTs. MSC treatment was associated with lower mortality rates in RCTs (risk ratio: 0.44; 95% CI: 0.28-0.69; P < .001). Fever and headache were among the most reported adverse effects.
Conclusions: Based on our review, MSC transplantation improves neurological deficits and daily activities in patients with IS. In the future, prospective studies with large sample sizes are needed for stem cell studies in ischemic stroke. This meta-analysis has been registered at PROSPERO with CRD42022347156.
期刊介绍：
STEM CELLS Translational Medicine is a monthly, peer-reviewed, largely online, open access journal.
STEM CELLS Translational Medicine works to advance the utilization of cells for clinical therapy. By bridging stem cell molecular and biological research and helping speed translations of emerging lab discoveries into clinical trials, STEM CELLS Translational Medicine will help move applications of these critical investigations closer to accepted best patient practices and ultimately improve outcomes.
The journal encourages original research articles and concise reviews describing laboratory investigations of stem cells, including their characterization and manipulation, and the translation of their clinical aspects of from the bench to patient care. STEM CELLS Translational Medicine covers all aspects of translational cell studies, including bench research, first-in-human case studies, and relevant clinical trials.
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