| Objective: In recent years,with the increasing morbidity of Heart Failure(HF)and the in-depth study of cell regeneration,a number of new therapeutic methods and new drugs have been widely used,in which the use of stem cell transplantation to promote the repair and regeneration of cardiac muscle cells has gradually become a new approach for the treatment of Heart Failure.Mesenchymal stem cells are getting more and more attention.Mesenchymal stem Cells(MSCs)are a kind of primitive stem Cells,mainly derived from the mesoderm.Under certain conditions,they can differentiate into cardiomyocytes,osteoblasts,chondrocytes,nerve Cells,adipocytes and other Cells.Among them,its role in cardiomyocyte differentiation has been applied in the treatment of heart failure.Currently,a number of clinical trials have shown that mesenchymal stem cell transplantation has a certain therapeutic effect on patients with heart failure,but there are differences in the baseline data and observation indexes set by various clinical trials.Therefore,this study used the method of meta-analysis to more comprehensively evaluate the safety and efficacy of mesenchymal stem cell transplantation in the treatment of heart failure.Methods: The computer retrieval Pubmed,The Cochrane Library,Embase,such as foreign language database,China hownet,VIP,ten thousand Chinese database,query The database published a placebo or ck mesenchymal stem cell transplantation therapy of heart failure related clinical Randomized Controlled Trials(Randomized Controlled Trials,RCT),retrieval time as of December 1,2020.References obtained through retrieval were reviewed and selected according to inclusion criteria and exclusion criteria to screen qualified literatures.The literature quality was evaluated according to the Cochrane Collaboration’s risk of bias criteria,and the included trial data were statistically analyzed using Review Manager 5.3 software.Relative Ratio(RR)and 95% Confidence Interval(CI)were used as effect value indexes.Results: A total of 384 patients with heart failure were included in the 9 RCTs,including 205 in the MSCS group and 179 in the control group.In the MSCs group,81 patients were injected with intracoronary mesenchymal stem cells,59 patients were injected with endocardial mesenchymal stem cells,and 65 patients were injected intravenously.In the MSCs group,90 patients were injected with BMC-derived mesenchymal stem cells,105 patients were injected with umbilical cord derived mesenchymal stem cells,and 10 patients were injected with non-labeled tissue derived mesenchymal stem cells.The remaining 179 patients in the control group received placebo or blank control in the same way.Results showed that,compared with controls,MSCs transplantation for heart failure(1)significantly reduced mortality(RR =0.52;95%CI[0.28,0.96],P=0.04),readmission rate(RR =0.63;95%CI[0.47,0.86],P=0.004);(2)Increase LVEF(MD =8.03;95%CI[6.557,9.52],P <0.00001),6MWT(MD =95.60;95%CI[24.17,167.03],P=0.009);(3)At the same time,the BNP(MD =-226.21;95%CI[-352.23,-100.18],P=0.004);(4)There was no statistical significance in the improvement of LVEDV(95%CI[-12.00,0.43],P=0.07)and LVESV(95%CI[-9.24,3.16],P=0.34)between the two groups.In addition,in terms of increasing LVEF,(1)MSCs treated with transcoronary injection(MD =8.76;95%CI[7.09,10.43],P < 0.00001)had better efficacy than intravenous injection(MD=5.34;95%CI[2.18,8.50],P=0.0009)(2)Bone marrow derived MSCs(M =6.7;SD[2.46,10.94])and umbilical cord derived MSCs(MD =8.24;95%CI[6.65,9.83],P< 0.00001).Conclusion: Mesenchymal stem cell transplantation can reduce the mortality and readmitted rate of patients with heart failure,increase LVEF,increase 6MWT,and decrease BNP value.However,there was no significant effect in improving LVEDV and LVESV.In addition,in terms of increasing LVEF,the efficacy of MSCs treated by coronary artery injection is superior to that treated by intravenous injection,and the efficacy of bone-marrow derived MSCs and umbilical cord derived MSCs is unclear.Our results suggest that mesenchymal stem cell transplantation is a safe treatment and can improve cardiac function and activity tolerance in patients with heart failure. |
