脱细胞神经支架联合干细胞构建组织工程神经修复坐骨神经缺损的meta分析

发布时间：2018-01-29 23:46

本文关键词：周围神经许旺细胞间质干细胞组织工程生物材料材料相容性周围神经缺损骨髓间充质干细胞脂肪间充质干细胞脱细胞神经支架组织工程神经疗效大鼠 RCT meta分析　出处：《中国组织工程研究》2017年22期 　论文类型：期刊论文

【摘要】：背景:研究表明,脱细胞神经支架不仅具有天然神经的空间三维结构,而且具有低免疫原性,但对于长段神经缺损的修复效果仍不理想。为此,有学者将脱细胞神经支架复合种子细胞构建组织工程神经,以提高其治疗效果。目的:系统评价脱细胞神经支架联合间充质干细胞或许旺细胞移植修复大鼠坐骨神经缺损的疗效。方法:检索PubM ed、The Cochrane Library、EMbase、CNKI、WanF ang和VIP数据库,查阅关于脱细胞神经支架联合间充质干细胞或许旺细胞修复大鼠坐骨神经缺损的随机对照实验,检索时限均为建库至2016年7月。由3名研究员按纳入和排除标准独立筛选文献、提取数据和评价文献的方法学质量,采用Review Manger5.3软件进行meta分析。结果与结论:最终10篇文献纳入研究,共计252只大鼠。Meta分析结果显示:(1)脱细胞神经支架联合间充质干细胞或许旺细胞组的坐骨神经功能指数均优于单纯脱细胞神经支架组:2周[SMD=2.73,95%CI(1.92,3.54),P0.000 01],4周[SMD=4.57,95%CI(3.43,5.70),P0.000 01],6周[SMD=1.62,95%CI(0.18,3.06),P=0.03],8周[SMD=4.90,95%CI(2.96,6.84),P0.000 01];(2)术后12周脱细胞神经支架联合间充质干细胞或许旺细胞组神经传导速度、潜伏期、振幅优于脱细胞神经支架组:神经传导速度[SMD=1.39,95%CI(0.99,1.78),P0.000 01],潜伏期[MD=-0.98,95%CI(-1.19,-0.76),P0.000 01],振幅[SMD=1.23,95%CI(0.62,1.85),P0.000 1];(3)脱细胞神经支架联合间充质干细胞或许旺细胞组髓鞘厚度均优于单纯脱细胞神经支架组:术后8周髓鞘厚度[MD=0.14,95%CI(0.07,0.21),P0.000 1],术后12周髓鞘厚度[SMD=1.85,95%CI(1.63,2.08),P0.000 01],术后12周有髓神经纤维数[SMD=3.59,95%CI(2.63,4.55),P0.000 01];(4)术后8周脱细胞神经支架联合间充质干细胞或许旺细胞组腓肠肌湿重优于单纯脱细胞神经支架组[SMD=4.22,95%CI(2.40,6.03),P0.000 01];(5)当前证据表明,脱细胞神经支架联合间充质干细胞或许旺细胞治疗大鼠坐骨神经缺损较单纯脱细胞神经支架更有助于神经再生和功能恢复。受纳入文献质量的限制,以上结论需更高质量、更大样本的随机对照实验加以验证。
[Abstract]:Background: studies have shown that acellular nerve scaffolds not only have the three-dimensional structure of natural nerve, but also have low immunogenicity, but the effect of repairing long nerve defects is still not ideal. Some researchers used acellular nerve scaffolds combined with seed cells to construct tissue-engineered nerves. Objective: to evaluate the efficacy of acellular nerve scaffold combined with mesenchymal stem cell transplantation in repairing sciatic nerve defect in rats. Methods: PubM ed was searched. The Cochrane Library The ang and VIP databases. A randomized controlled trial of acellular nerve scaffolds combined with mesenchymal stem cells or stromal cells to repair sciatic nerve defects in rats was reviewed. The retrieval time is from the establishment of the database to July 2016. Three researchers independently sift through the literature according to the inclusion and exclusion criteria to extract data and evaluate the methodological quality of the literature. Meta analysis was carried out with Review Manger5.3 software. Results and conclusions: finally, 10 articles were included in the study. The results of meta analysis of 252 rats showed that the function index of sciatic nerve in acellular nerve stents combined with mesenchymal stem cells might be better than that in acellular nerve stents alone for 2 weeks. [SMD2.73 / 95CIQ 1.92 / 3.54 / P0.00001] / 4 weeks. [SMD4.57 / 95CIQ 3.43 / 5.70 / P0.00001] / 6 weeks. [SMD1.62 / 95CIQ 0.18 / 3.06 / P0.03] for 8 weeks. [SMD4.90 / 95 CIQ 2.96 / 6.84 / P0.00001; (2) 12 weeks after operation, the nerve conduction velocity, latency and amplitude of acellular nerve stent combined with mesenchymal stem cell may be better than that of acellular nerve stent group: nerve conduction velocity. [SMD1.39 ~ 95CIQ 0.99 / 1.78 P0.00001], latent period. [MD-0.98 / 95 CIQ -1.19 ~ 0.76 P0.00001], amplitude. [SMD1.23 ~ 95CIQ 0.62 ~ 1.85 P0.0001]; (3) the thickness of myelin sheath in the acellular nerve scaffold combined with mesenchymal stem cells might be better than that in the pure acellular nerve stent group: the thickness of myelin sheath was 8 weeks after operation. [MDT 0.14 ~ 95% CIQ 0.07 0. 21% P0. 000 1]. The thickness of myelin sheath was 12 weeks after operation. [The number of myelinated nerve fibers at 12 weeks after operation was 1.85%, 1.63% 2.08% (P0.00001). [SMD3.59 / 95CIQ 2.63 / 4.55 / P0.00001; (4) 8 weeks after operation, acellular nerve stents combined with mesenchymal stem cells may be superior to simple acellular nerve stent group in wet weight of gastrocnemius muscle. [SMD4.22 / 95 CIQ 2.40 / 6.03 / P0.00001]; Current evidence suggests. Acellular nerve stents combined with mesenchymal stem cells may be more helpful for nerve regeneration and functional recovery than acellular nerve scaffolds in the treatment of sciatic nerve defects in rats. These conclusions need to be verified by a randomized controlled trial with a higher quality and larger sample.
【作者单位】：西南医科大学附属医院骨与关节外科;西南医科大学;
【基金】：四川省科技厅项目(2014JY0248)~~
【分类号】：R318.08;R688
【正文快照】： 0引言Introduction细胞等[6]。在神经缺损修复过程中,种子细胞能够促进有周围神经缺损是临床常见病、多发病,其预后不佳,髓神经纤维、轴突的再生,同时能分泌大量细胞生长因子,有较高的致残率[1]。学者一直致力寻求神经的理想桥接物,改善神经修复的微环境[7]。目前国内外已有较

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