摘要
目的:间充质干细胞(mesenchymal stem cell,MSC)用于治疗难治性系统性红斑狼疮(systemic lupus erythematosus,SLE)和狼疮性肾炎已有10余年的历史,但相关研究多为自身对照研究,随机对照研究(randomized controlled trial,RCT)较少,循证医学证据不足。本研究采用荟萃分析方法系统评价MSC治疗SLE的有效性。方法:计算机检索Pub Med数据库、Cochrane Library数据库、万方数据库、维普全文数据库发表的采用MSC治疗SLE的RCT和自身对照研究,截止日期至2018年6月1日。由2位研究者独立按照纳入与排除标准实施文献筛选和数据收集。以SLE疾病活动评分、24 h尿蛋白定量和补体C3定量为研究终点,应用Revman 5. 3软件进行荟萃分析。结果:共纳入8项研究,共213例患者,其中3项研究为RCT,包含66例患者。分析结果显示,MSC可降低SLE疾病活动评分[标准化均数差(standard mean difference,SMD)=-1. 76,95%CI:-2. 00～-1. 51,P <0. 001],可降低蛋白尿水平(SMD=-1. 74,95%CI:-2. 46～-1. 03,P <0. 001),改善补体C3水平(SMD=1. 28,95%CI:0. 93～1. 62,P <0. 001)。共有4项研究报道了不良事件。结论:MSC可用于治疗难治性SLE和狼疮性肾炎,现有证据表明,其可改善疾病活动程度、蛋白尿和补体水平,确切疗效仍需进一步大规模高质量的RCT证实。
Objective： Systemic lupus erythematosus（ SLE） is an autoimmune disease with multi-organ involvement and several typical autoantibodies. Mesenchymal stem cells（ MSC） are multipotent stem cells with low immunogenicity that can differentiate into various kinds of cells,such as bone,cartilage,fat and skin tissue. MSC have immunomodulatory and reparative properties through interactions with immune cells. MSC have been used in the treatment of refractory SLE and lupus nephritis patients for more than ten years. Most clinical studies were self-controlled studies and only a few were randomized controlled trials. The objective of this study was to use meta-analysis method to evaluate the efficacy and safety of MSC treatment in SLE patients. Methods： The PubMed,Cochrane Library,Wanfang and VIP databases were searched for published randomized controlled trials and self-controlled studies before June1,2018. The search terms included the Chinese and English versions of mesenchymal stem cells,Mesenchymal Stromal Cells [Mesh ],systemic lupus erythematosus,lupus,Lupus Erythematosus,Systemic[Mesh]. Two authors independently screened the literatures,assessed the quality of the studies and collected data according to the inclusion and exclusion criteria. The endpoints were the SLE disease activity index,24 h urine protein and complement C3. Meta-analysis was performed with the Revman 5. 3 software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses（ PRISMA）standard. Results： Eight studies involving 213 patients were included and three of the studies were randomized controlled trials with 66 patients involved. The MSC group showed that the SLE disease activity index decreased significantly [standard mean difference（ SMD） =-1. 76,95% confidence interval（ CI） ：-2. 00 to-1. 51,P〈0. 001）,the 24 h urine protein decreased significantly（ SMD =-1. 74,95% CI：-2. 46 to-1. 03,P〈0. 001）,as well as the complement C3 increased significantly（ SMD =1. 28,95% CI： 0. 93 to 1. 62,P〈0. 001）. Four studies reported adverse events including fever,diarrhea and headache during the infusion. Conclusion： Current evidences showed that MSC could improve the disease activity,proteinuria and hypocomplementemia in SLE patients. Large scale and high-quality randomized controlled trials are required to validate the efficacy and safety of MSC treatment in SLE patients.
作者
刘爽
郭雨龙
杨静逸
王维
徐健
LIU Shuang;GUO Yu-long;YANG Jing-yi;WANG Wei;XU Jian(Department of Rheumatology and hnmunology,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Cardiology,Yunnan Provincial Fuwai Cardiovascular Disease Hospital,Kunming 650000,China;Yunnan Shunxi Regeneration Medical Engineering Co.,Ltd,Kunming 650000,China)
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2018年第6期1014-1021,共8页
Journal of Peking University:Health Sciences
基金
国家自然科学基金(81160379
81460256
81560233
81501406
81760296)
云南省科技厅-昆明医科大学应用基础研究联合基金[2017FE467
2017FE467(-138)]
云南省医疗卫生单位内设研究机构科研项目(2014NS171
2016NS026
2016NS052
2017NS051
2018NS0133
2018NS0134)
云南省高层次卫生计生技术后备人才基金(H-2017068)
云南省中青年学术技术带头人后备人才基金(2015HB071)
昆明医科大学"百名中青年学术和技术骨干"基金(60117190457)
昆明医科大学科技创新团队建设项目(CXTD201613)~~
