Meta分析间充质干细胞治疗肝衰竭的效果

肝脏 ›› 2023, Vol. 28 ›› Issue (12): 1413-1417.

Meta分析间充质干细胞治疗肝衰竭的效果

李平, 谢芳, 郑文凯, 孙浩男, 姚传霞, 汪勇

210002 江苏南京东部战区总医院秦淮医疗区肝病科(李平,谢芳,郑文凯,孙浩男,姚传霞);东部战区总医院门诊部(汪勇)

收稿日期:2023-02-12 出版日期:2023-12-31 发布日期:2024-03-01
通讯作者: 汪勇,Email:13675175999@139.com
基金资助:
东部战区总医院院管课题YYMS2021039

A meta-analysis on the therapeutic effect of mesenchymal stem cells on liver failure patients

LI Ping, XIE Fang, ZHENG Wen-kai, SUN Hao-nan, YAO Chuan-xia, WANG Yong

Department of Liver Disease, Qinhuai Medical District, General Hospital of the Eastern Theater, Nanjing 210002, China

Received:2023-02-12 Online:2023-12-31 Published:2024-03-01
Contact: WANG Yong , E-mail:leep2002@163.com

摘要/Abstract

摘要： 目的通过循证医学分析间充质干细胞治疗肝衰竭的临床疗效。方法采用RevMan 5.3统计软件对国内外发表的17篇关于间充质干细胞治疗肝衰竭的病例-对照研究进行Meta分析。主要评价指标为生存率,次要指标为肝生化指标和MELD评分。结果 17篇文献共纳入1054例患者,不同时期间充质干细胞治疗组生存率均优于常规治疗组(4周OR=5.45,95%CI: 2.80~10.59,P<0.01;8周OR=2.82,95%CI: 1.74~ 4.58,P<0.01;12周OR=2.59,95%CI: 1.76~ 3.80,P<0.01;24周OR=2.13,95%CI: 1.43~3.17,P<0.01);MELD评分在12周(MD=-2.89,95%CI: -5.02~-0.75,P=0.008)和24周(MD=-2.28,95%CI: -4.27~-0.30,P=0.02)均具有显著差异,而两组患者大部分肝生化指标差异不明显。结论间充质干细胞治疗肝衰竭可提高患者生存率,是一种有效的细胞治疗方法,具有临床应用价值。

关键词: 间充质干细胞, 肝衰竭, Meta分析

Abstract: Objective To analyze the clinical efficacy of mesenchymal stem cells on the treatment of liver failure through evidence-based medicine.Methods Seventeen case-control studies published at domestic and international journals on mesenchymal stem cells in the treatment of liver failure were analyzed with RevMan 5.3 statistical software. The primary evaluation index was survival rate, and the secondary index was liver biochemical index and end-stage liver disease model score (MELD).Results A total of 1054 subjects were included in 17 articles. The survival rates of the mesenchymal stem cells treatment group were better than those of the control group at different periods of time (4 weeks OR=5.45, 95%CI 2.80~10.59, P<0.001; 8 weeks OR=2.82, 95%CI 1.74~4.58, P<0.001; 12 weeks OR=2.59, 95%CI 1.76~3.80, P<0.001; 24 weeks OR=2.13, 95%CI 1.43~3.17, P<0.001); MELD scores showed significant differences at 12 weeks (MD=-2.89, 95%CI -5.02~-0.75, P=0.008) and 24 weeks (MD=-2.28, 95%CI -4.27~-0.30, P=0.02). There was no significant difference in most liver biochemical indexes between the two groups.Conclusion Mesenchymal stem cells treatment can improve the survival rate and long-term MELD score of patients with liver failure. It is an effective cellular therapeutic method with value of clinical application.

Key words: Mesenchymal stem cells, Liver failure, Meta analysis

李平, 谢芳, 郑文凯, 孙浩男, 姚传霞, 汪勇. Meta分析间充质干细胞治疗肝衰竭的效果[J]. 肝脏, 2023, 28(12): 1413-1417.

LI Ping, XIE Fang, ZHENG Wen-kai, SUN Hao-nan, YAO Chuan-xia, WANG Yong. A meta-analysis on the therapeutic effect of mesenchymal stem cells on liver failure patients[J]. Chinese Hepatolgy, 2023, 28(12): 1413-1417.

参考文献

[1] 刘景丰,张翔. 肝衰竭的肝移植治疗进展[J]. 中华肝脏病杂志,2017, 25: 655-658.
[2] 朱冰,辛绍杰,游绍莉. 肝衰竭前期的预警及治疗研究进展[J]. 中华肝脏病杂志,2020, 28: 298-301.
[3] Wang M, Zhang X, Xiong X I, et al. Bone marrow mesenchymal stem cells reverse liver damage in a carbon tetrachloride-induced mouse model of chronic liver injury[J]. In Vivo, 2016, 30: 187-193.
[4] 姚鹏,胡大荣,王帅,等. 自体骨髓干细胞移植治疗慢性肝衰竭研究[J]. 肝脏,2005, 10: 171-173.
[5] 康海燕,刘莲,王建彬,等. 人自体骨髓干细胞移植治疗慢性重型肝炎的研究[J]. 临床肝胆病杂志,2009, 25: 296-297.
[6] 康海燕,许文进,赵子龙,等. 自体骨髓干细胞移植联合胸腺肽α1治疗肝衰竭的临床研究[J].山东医药, 2012, 52: 68-69.
[7] 刘波,董静,张骏飞,等. 人脐带问充质干细胞治疗慢加急性肝衰竭患者近期疗效与安全性分析[J]. 实用肝脏病杂志, 2013: 29-31.
[8] 翁伟镇,陈俊峰,梅咏予,等. 异体骨髓间充质干细胞治疗不同时相慢加急性乙肝肝衰竭患者的疗效[J]. 中山大学学报(医学科学版),2013, 34: 422-428.
[9] 何宏亮,许文雄,王培培,等. 人脐带间充质干细胞治疗慢加急性乙肝肝衰竭的安全性及临床效果[J]. 热带医学杂志,2015, 15: 1625-1628.
[10] 李元元,徐若男,施明,等. 人脐带间充质干细胞治疗慢加急性肝衰竭患者的初步临床观察[J]. 中华细胞与干细胞杂志(电子版),2015, 5: 32-36.
[11] Li YH, Xu Y, Wu HM, et al. Umbilical cord-derived mesenchymal stem cell transplantation in hepatitis B virus related acute-on-chronic liver failure treated with plasma exchange and entecavir: a 24-month prospective study[J]. Stem Cell Rev Rep,2016, 12: 645-653.
[12] Lin BL, Chen JF, Qiu WH, et al. Allogeneic bone marrow-derived mesenchymal stromal cells for hepatitis B virus-related acute-on-chronic liver failure: a randomized controlled trial[J]. Hepatology,2017, 66: 209-219.
[13] 张茜,罗燕,李艳春,等. 脐血干细胞肝动脉移植治疗慢性肝衰竭的临床研究. 贵阳中医学院学报,2017, 39: 64-67.
[14] 张岁,柳立平,马文波,等. 脐带间充质干细胞移植治疗慢性肝衰竭[J]. 中国组织工程研究,2017, 21: 2056-2061.
[15] 郭锐,邓宇,郭玲. 自体骨髓干细胞移植治疗肝衰竭患者临床疗效及安全性的随机对照试验研究[J]. 实用肝脏病杂志,2017, 20: 612-613.
[16] Xu WX, He HL, Pan SW, et al. Combination Treatments of Plasma Exchange and Umbilical Cord-Derived Mesenchymal Stem Cell Transplantation for Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure: A Clinical Trial in China[J]. Stem Cells Int, 2019, 2019: 4130757.
[17] 闫焕杰,张淑芹,赵文静. 自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者疗效初步研究[J]. 实用肝脏病杂志,2019, 22: 81-84.
[18] 陈曦,陈照林,董静,等. 脐带间充质干细胞联合双重血浆分子吸附治疗慢加急性肝衰竭患者临床效果初步观察[J]. 实用肝脏病杂志,2020, 23: 544-547.
[19] 宋玉,王芳. 自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者疗效初步研究[J]. 实用肝脏病杂志, 2020, 23: 388-391.
[20] Schacher FC, Martins PDSA, Silla L, et al. Bone marrow mesenchymal stem cells in acute-on-chronic liver failure grades 2 and 3: a phase I-II randomized clinical trial[J]. Can J Gastroenterol Hepatol, 2021: 3662776.
[21] 罗秋敏, 朱姝, 彭亮, 等. 间充质干细胞源性外泌体治疗肝衰竭的研究进展[J]. 中华肝脏病杂志, 2022, 30: 249-252.