| Objective:To evaluate the efficacy and safety of mesenchymal stem cells(MSCs)for the treatment of crohn’s disease(CD)perianal fistulas,in order to provide reference for clinical practice and research.Methods : We searched Pubmed,Cochrane Library,Embase,CNKI,and collected all information about MSCs for the treatment of Crohn’s disease perianal fistulas in randomized controlled trials(RCTs),non-randomized controlled trials and non-randomized experimental studies and so an.Two reviewers screened documents and extracted information according to inclusion and exclusion criteria,and then using RevMan software5.3、R software for Meta-analysis.Results : Finally,11 studies,contained 4 RCT articles,7non-randomized experimental studies.Using RevMan5.3 software for meta-analysis showed that:(1)The meta analysis of 4 RCT articles showed the healing rate of fistula was 51.94% with MSCs,with an odds ratio of2.06(P=0.006,CI: 1.23 ~ 3.45)versus control.(2)The 3 RCT articles adopted MRI + clinical examination to assess the healing of anal fistulaalso show that the healing rate of fistula was higher than control group(OR= 1.87,CI: 1.10 ~ 3.19,P=0.02).Using R software for single-group meta-analysis showed that the total healing rate of fistual was 61%(95% CI:0.50~0.75),the total clinical response rate of fistula was 34%(95% CI:0.22~0.53),when combined MRI with clinical examination to evaluate fistula,The overall healing rate of fistula was 51%(95% CI: 0.43 ~0.59).Subgroup analysis showed that autologous MSCs with a pooled rate of fistula healing of 78%(95% CI:0.70 ~ 0.87),the healing rate of allogeneic MSCs was 49%(95% CI:0.41~0.58),that autologous MSCs are superior to allogeneic MSCs(P<0.05).the healing rate of adipose-derived MSCs was 62%(95% CI: 0.49 ~ 0.78),the healing rate of bone marrow-derived MSCs was 57%(95% CI: 0.40 ~ 0.82),there were not significantly different in the two groups(P>0.05).MSCs combined with anti-TNF agents that the total healing rate of fistula was 59%(95% CI:0.42 ~ 0.83),When used MSCs that should to stop continuing use of anti-TNF agents,the total healing rate of fistula was 61%(95% CI: 0.45~0.82),there were not significantly different in the two groups(P>0.05).The healing rate of fistula was 80%(95% CI: 0.71~0.90)when the volume of injected cells were proportional to fistula size.The healing rate of fistula was 54%(95% CI: 0.47 ~ 0.63)when use fixed-dose MSCs,there were significantly different in the two groups(P<0.05).Overall,intra-fistular injection of MSCs is effective,and the adverse events related to MSCs werenot reported in clinical studies.Conclusion:MSCs have good therapeutic potential with relatively low risk of adverse reactions for patients with CD perianal fistulas,particularly for those who are refractory to conventional medical treatment strategies(ie,antibiotics and immuno modulators)and anti-tumour necrosis factor(anti-TNF)treatments or surgery. |
PDF Full Text Request