| Spinal cord injuries cause motor and sensory disorders and urinary system disorders in patients,which has a great impact on the life,work and lifetime of patients,and at the same time cost massively in treatment and rehabilitation.Due to different pathogenic factors,different time of post-injury and different degree of injury,the treatment methods after SCI are also different.Therefore,various factors should be taken into consideration when choosing the treatment methods after SCI.With the development of stem cell transplantation technologies,the safety of stem cell transplantation and its efficacy in the treatment of SCI in animal models have been studied.The studies confirmed that BBB score of animal SCI models was improved after stem cell transplantation,and there was functional recovery at the injured site.Today,stem cell transplantation to treat SCI also develops gradually from animal experiments to clinical trials,but in all kinds of clinical trials,because of the different categories of stem cells,different ways and numbers of cell transplantation,and differentdegree of injury of SCI patients lead to the curative effect of stem cell transplantation to treat SCI vary widely.Therefore,this study will use a meta-analysis method to carry out an in-depth analysis of published clinical trial studies in order to provide a theoretical basis for the treatment of SCI with stem cell transplantation.Methods:First,Pubmed,Ovid Medline and Web of science databases were searched,according to Me SH and free words,and then duplicate literature was deleted.The remaining literatures were selected from the abstract or full text of the literatures according to inclusion and exclusion criteria,and the full text of all the included literatures was downloaded.Then two researchers carried out information extraction of literatures in accordance with the standards set.The Review Manage5.3statistical software was used for quality evaluation and heterogeneity inspection,the percentage of patients with improved ASIA scores in the control and stem cell transplantation groups is analyzed,and systemic review for the Urodynamic indexevaluation and adverse reactions.Results:The heterogeneity of the 8 included literatures was low and the risk of quality evaluation was moderate.The OR value of the percentage of improved ASIA score was at the right of the invalid line(i.e.OR=1),and the 95%CI didn't contain the invalid line,which indicates that the ASIA score of the stem cell transplantation group was significantly improved(OR=7.55,95%CI: 3.64-15.65,p<0.00001).Urodynamic indices showed improvement in bladder function in patients with SCI after stem cell transplantation.In the pre-treatment injury subgroups,studies with an ASIA score of A showed significant improvement in ASIA score of the stem cell transplantation group(OR=6.87,95%CI: 3.32-14.23,p<0.00001).There was no statistical difference in ASIA score between the stem cell transplantation group and the control group in studies with an ASIA score of B(OR=9.78,95%CI: 0.79-121.31,p=0.08).In the subgroups of cell numbers,there was no statistical difference in ASIA score in the study with n*10~6 cells(OR=4.72,95%CI: 0.86-26.04,p=0.07).The studies of n*10~7and n*10~8 cells showed that the ASIA score was significantly improved(OR=42.56,95%CI: 4.92-368.26,p=0.0007)(OR=5.51,95%CI: 1.74-17.44,p=0.004).In the subgroups of transplantation methods,studies on the treatment of stem cell transplantation by LP,injected into lesion site and injected into cystic cavity and intravenous drip showed that the ASIA score was significantly improved(OR=9.50,95%CI: 2.24-40.21,p=0.002)(OR=10.43,95%CI: 3.11-35.01,p=0.0001)(OR=5.20,95%CI: 1.25-21.57,p=0.02).In the subgroups of transplanted cell types,studies with BM-MSCs,UC-MSCs and BM-mononuclears transplantation for SCI,indicated that the ASIA score was significantly improved(OR=7.56,95%CI: 2.85-20.03,p<0.0001)(OR=45.00,95%CI: 2.01-1006.75,p=0.02)(OR=5.20,95%CI: 1.25-21.57,p=0.02).Study with h NSPCs showed no statistical difference in ASIA score(OR=5.00,95%CI: 0.52-48.46,p=0.16).Conclusion:Stem cell transplantation for SCI can improve ASIA score,improve sensorimotor function and bladder function.The more severe the degree of SCI before transplantation,the more significant the improvement of ASIA score.After BM-MSCs,UC-MSCs and BM-mononuclears transplantation ASIA scores improved,but not improved after h NSPCs transplantation.The ASIA score improved significantly after the cell transplantation numbers was greater than 10~7.ASIA score was improved after the transplantation of stem cells by LP,injected into lesion site and injected into cystic cavity and intravenous drip. |
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