关键词: 骨髓, 干细胞, 移植, 心肌梗死, 随机对照试验, Meta分析

Abstract: Objective To evaluate systematically the clinical efficacy and safety of bone marrow-derived stem cell therapies for patients with acute myocardial infarction. Methods Pubmed, EMbase, the Cochrane Library, VIP database,Wan fang database and CNKI database were searched by computer for randomized controlled trials of bone marrow-derived stem cell therapies in patients with acute myocardial infarction. The retrieval time was from the setup of the database to May 2018. Two systematic evaluators screened the literatures according to the inclusion and exclusion standard, and extracted the important information of literature. After assessing the quality of included studies, the risk of bias was analyzed by RevMan 5.2 software, and Meta-analysis was evaluated by Stata 14.0 software. Results There were 39 case-control studies included in systematic screening including total of 3 314 patients of acute myocardial infarction (1 879 cases received transplantation and 1 435 cases were control). Heterogeneity test showed that there was no significant heterogeneity in the included studies, and Begg’s and Egger’s quantitative tests showed that there was no publication bias among the included studies (P＞0.1). Compared with the control group, bone marrow-derived stem cells could improve effectively left ventricular end diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV), but there were no significant differences in left ventricular ejection fraction (LEVF) and myocardial infarction area (MIS) after infusion of bone marrow-derived stem cells between the two groups. The sensitivity analysis showed that the 39 included studies had less influence on the combination effect of the outcome indicators, and the stability was good, and the results were more credible. Seven studies reported different degrees of adverse reactions after stem cell transplantation, including death, in-stent restenosis and coronary occlusion. Whether these adverse effects are related to cell infusion remains to be further studied. Conclusion The results from systematic evaluation and Meta-analysis suggest that bone marrow-derived stem cell transplantation can improve left ventricular remodeling of patients with acute myocardial infarction, and its clinical safety requires further evaluation of multicenter clinical trials and long-term follow-up.

Key words: bone marrow, stem cells, transplantation, myocardial infarction, randomized controlled trial, Meta-analysis