摘要
目的系统评价关节腔内注射间充质干细胞(MSCs)与透明质酸治疗膝OA的有效性及安全性。方法系统检索PubMed、Embase、中国知网(CNKI)、万方数据库、中国生物医学数据库(CBM)等数据库,搜集筛选出关于关节腔内注射MSCs对比透明质酸治疗膝OA的临床随机对照试验(RCT),检索时间从建库至2020年5月,按照入选和排除标准对文献进行筛查、提取信息及评价偏倚风险后采用RevMan 5.3软件行Meta分析。结果最终纳入文献13篇,共726例膝关节OA患者。Meta分析结果可见:对比透明质酸组,MSCs组治疗后,西安大略和麦克马斯特大学骨关节炎指数总评分(WOMAC)明显下降[MD=-10.92,95%CI(-16.87,-4.96),P<0.01],视觉模拟量表(VAS)评分显著下降[MD=-1.70,95%CI(-2.44,-0.95),P<0.01],膝关节Lequesne指数评分显著降低[MD=-13.78,95%CI(-15.03,-12.52),P<0.01],2组不良事件(AEs)发生率比较差异无统计学意义[RR=1.11,95%CI(0.90,1.37),P=0.33]。美国膝关节协会评分(AKS)评分[MD=-10.15,95%CI(-22.33,2.03),P=0.10]及磁共振评分体系(WORMS)评分[MD=-3.93,95%CI(-11.60,3.75),P=0.32]分析结果差异无统计学意义,提示关节腔内注射MSCs可显著改善膝OA患者关节疼痛和功能障碍,而不良事件的发生率在MSCs组与透明质酸组差异无统计学意义(P>0.05)。结论MSCs治疗膝OA后,患者关节症状及功能明显改善、生存质量得到提高,同时具有较好的安全性,有望成为膝OA改善临床症状及预后的新型治疗方法。
Objective To systematically evaluate the effectiveness and safety of intra-articular in-jection of mesenchymal stem cells(MSCs)and hyaluronic acid(HA)in the treatment of knee osteoarthritis.Methods The relevant literatures published in both English and Chinese were systematically searched in PubMed,Embase,Wanfang database,China Knowledge Network(CNKI),SinoMed database and other data-bases from inception to May 2020.Two researchers independently extracted data and evaluated the included literature.Risk assessment of literature bias was carried out.RevMan 5.3 software was used for Meta analysis,and the combined sensitivity were calculated.Results Finally,13 references were included,including a total of 726 patients with knee osteoarthritis.Meta-analysis results showed that compared with the HA group,the Western Ontario and McMaster University Osteopathic Index Total Score(WOMAC)[MD=-10.92,95%CI(-16.87,-4.96),P<0.01],the visual analogue scale(VAS)score[MD=-1.70,95%CI(-2.44,-0.95),P<0.01],and the knee joint Lequesne index score of MSCs group all decreased significantly[MD=-13.78,95%CI(-15.03,-12.52),P<0.01].Furthermore,there was no significant difference in the incidence of adverse events(AEs)between the two groups[RR=1.11,95%CI(0.90,1.37),P=0.33].However,American Knee Association Score(AKS score)[MD=-10.15,95%CI(-22.33,2.03),P=0.10]and whole-organ magnetic resonance imaging score(WORMS)[MD=-3.93,95%CI(-11.60,3.75),P=0.32]were not statistically significant(P>0.05).Conclusion Compared with intra-articular injection of HA,intra-articular injection of MSCs can significantly improve the symptoms and dysfunction,and has favorable clinical tolerability and safety,suggesting that MSCs is expected to bea new treatment for knee osteoarthritis.
作者
李欠欠
王苏丽
邢飞
吕良敬
Li Qianqian;Wang Suli;Xing Fei;Lyu Liangjing(Department of Rheumatology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200001,China;Department of Orthopedics,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2021年第1期15-25,共11页
Chinese Journal of Rheumatology
基金
国家重点研究发展计划(2017YFC0909002)
国家自然科学基金面上项目(81974251)
上海申康新兴前沿技术联合攻关项目(SHDC12018106)
上海市中西医临床协作试点项目建设(ZY(2018-2020)-FWTX-1009)。
关键词
间充质干细胞
透明质酸
骨关节炎
META分析
随机对照试验
Mesenchymal stem cells
Hyaluronic acid
Osteoarthritis
Meta analysis
Randomized controlled trials
