目的 评价经冠状动脉移植骨髓干细胞治疗急性心肌梗死(AMI)的远期效果.方法 计算机检索MEDLINE(1950~2015.02)、EMBASE(1980~2015.02)和Cochrane图书馆(2015.02).按纳入及排除标准由两名研究者独立进行筛选,并提取资料,采用Cochrane协作网偏倚评价工具评价所纳入的研究,应用STATA12.0和RevMan5.3软件进行Meta分析.结果 共纳入11项随机对照试验,共1532例患者,平均随访32个月.Meta分析结果表明,与对照组相比,骨髓单个核细胞移植治疗可明显提高左室射血分数4.47%(95%CI:3.17~5.77,P<0.01),明显减少左室舒张末期容积和左室收缩末期容积.但对全因死亡、再发心肌梗死和心力衰竭入院率无明显影响.结论 经冠状动脉注射自体骨髓单个核细胞可改善AMI后心脏功能,但对心血管不良事件的发生无明显影响.由于本研究入选的临床试验规模都较小,研究质量有些缺陷,需要更多设计良好、大规模临床试验来证实.%Objective To review the long-term effectiveness of intracoronary transplantation of autologous marrow mononuclear cell in treatment of acute myocardial infarction (AMI).Methods The databases of MedLine (1950~2015.2), EMbase (1980~2015.2) and Cochrane Library (2015.2) were retrieved with computer, and the data was screened and extracted by 2 independent researchers according to inclusion and exclusion criteria. The included data was reviewed by using Cochrane bias review tool, and given the Meta-analysis by using STATA12.0 software and RevMan5.3 software.Results There were totally 11 clinical controlled trials (1532 cases) included and followed up for 32 m averagely. The results of Meta-analysis showed that the transplantation of autologous marrow mononuclear cell increased left ventricular ejection fraction (LVEF) by 4.47% (95%CI: 3.17~5.77, P<0.01), and decreased significantly left ventricular end-diastolic volume and left ventricular end-systolic volume in treatment group compared with control group, but the implantation had no significant influence on all-cause mortality, relapsed myocardial infarction and admission rate due to heart failure.Conclusion The transplantation of autologous marrow mononuclear cell can improve the heart function after AMI but had no significant influence on adverse cardiovascular events. As the scale of clinical trials is smaller in this study and quality is lower, more clinical trials with better design and large scale are needed to confirming the conclusion.
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