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2022, Vol. 26 ›› Issue (7): 1085-1092Systematic evaluation of different therapeutic effects of mesenchymal stem cell transplantation in the treatment of ischemic strokeFang Xiaolei¹, Leng Jun², Zhang Chen¹, Liu Huimin¹, Guo Wen¹
Abstract: OBJECTIVE: To conduct a meta-analysis of the efficacy and safety of mesenchymal stem cells in the treatment of ischemic stroke and to compare the clinical efficacy of different mesenchymal stem cells transplantation pathways. METHODS: PubMed, CNKI, Wanfang data, VIP, Web of Science, and SinoMed were searched, and randomized controlled trials of mesenchymal stem cells in the treatment of ischemic stroke published from January 2005 to March 2021 were collected. The control group received conventional treatment. The stem cell group received mesenchymal stem cell transplantation. The literature quality was assessed using the bias assessment tool recommended by the Cochrane Collaboration. The included primary outcome measures National Institute of Health Stroke Scale score, secondary outcome index modified Rankin Scale score, function independent measure score, Fugl-Meyer assessment score, Barthel index score, and post-treatment adverse outcome were analyzed using RevMan 5.3 and Stata 16.0 software. The network meta-analysis was performed for the National Institute of Health Stroke Scale score of neurological impairment. RESULTS: Seventeen randomized controlled trials were included, and the quality of the included articles was generally average. A total of 936 ischemic stroke cases were included. (1) Results of meta-analysis showed that mesenchymal stem cells were superior to conventional treatment group in reducing National Institute of Health Stroke Scale score and modified Rankin Scale score of neurological impairment, improving Fugl-Meyer assessment motor function score, Barthel index score of daily living ability, and functional independence Function independent measure score (P < 0.05). (2) The results of network meta-analysis showed that compared with the conventional treatment group, subarachnoid injection combined with intravenous injection could significantly reduce the National Institute of Health Stroke Scale score (P < 0.05) and promote the recovery of neurological function. SUCRA cumulative probability: Subarachnoid injection combined with intravenous injection (79.0%) > stereotactic implantation (71.3%) > subarachnoid injection (55.8%) > intravenous injection (43.0%) > carotid injection (36.5%) > routine treatment (14.4%). The effect of subarachnoid injection combined with intravenous injection was better than other transplantation methods. CONCLUSION: Mesenchymal stem cells can effectively improve neurological function, improve motor function, daily living ability and functional independence in patients with ischemic stroke, and mesenchymal stem cell transplantation is relatively safe. The combination of subarachnoid injection and intravenous injection may be an optimal path to improve the neural function of mesenchymal stem cell transplantation after ischemic stroke. Key words:stem cells, stem cell transplantation, mesenchymal stem cells, stroke, cerebral infarction, bone marrow mesenchymal stem cells, umbilical cord mesenchyma stem cells, peripheral blood stem cells |