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目的:对随访期2年或以上的随机对照试验进行Meta分析,探讨骨髓干细胞(BMC)移植对急性心肌梗死后患者远期左室收缩功能的影响。方法:系统检索数据库Medline、Embase、Cochrane图书馆和Cochrane对照试验注册中心、中国生物医学磁盘数据库;时间为从建库到2012年7月。用统一表格提取资料,应用RevMan 5.0软件进行定量分析。结果:6篇临床试验合计551名患者纳入本Meta分析。与对照组相比,BMC移植使左室射血分数(LVEF)显著增加(5.09%,95%CI:2.67%~7.52%,P<0.001)。亚组分析显示,基线LVEF低于42%的患者从BMC治疗中获益明显,LVEF显著改善,而基线LVEF高于42%的患者未能从中获益。结论:BMC移植能够在标准治疗的基础上进一步增加急性心肌梗死后的LVEF,改善左室收缩功能,该效应至少能保持2年以上。该效应还需要未来大规模随机对照试验来证实。
OBJECTIVE: To evaluate the effect of bone marrow stem cell (BMC) transplantation on long-term left ventricular systolic function after acute myocardial infarction in a randomized controlled trial of follow-up of 2 years or more. Methods: The database of Medline, Embase, Cochrane Library and Cochrane Central Register of Controlled Trials, China Biomedical Disk Database was established. The time ranged from building database to July 2012. Data were extracted using a unified form and quantified using RevMan 5.0 software. RESULTS: A total of 551 patients were included in this meta-analysis of 6 clinical trials. Compared with the control group, BMC transplantation significantly increased left ventricular ejection fraction (LVEF) (5.09%, 95% CI: 2.67% -7.52%, P <0.001). Subgroup analyzes showed that patients with a baseline LVEF of less than 42% benefited significantly from BMC treatment with a significant improvement in LVEF, whereas patients with a baseline LVEF of 42% did not benefit. Conclusion: BMC transplantation can further increase LVEF after acute myocardial infarction and improve left ventricular systolic function on the basis of standard treatment, which can be maintained for at least 2 years. This effect also needs future large-scale randomized controlled trials to confirm.