本文關(guān)鍵詞： 周圍神經(jīng) 許旺細(xì)胞 間質(zhì)干細(xì)胞 組織工程 生物材料 材料相容性 周圍神經(jīng)缺損 骨髓間充質(zhì)干細(xì)胞 脂肪間充質(zhì)干細(xì)胞 脫細(xì)胞神經(jīng)支架 組織工程神經(jīng) 療效 大鼠 RCT meta分析　出處：《中國組織工程研究》2017年22期 　論文類型：期刊論文

【摘要】：背景:研究表明,脫細(xì)胞神經(jīng)支架不僅具有天然神經(jīng)的空間三維結(jié)構(gòu),而且具有低免疫原性,但對于長段神經(jīng)缺損的修復(fù)效果仍不理想。為此,有學(xué)者將脫細(xì)胞神經(jīng)支架復(fù)合種子細(xì)胞構(gòu)建組織工程神經(jīng),以提高其治療效果。目的:系統(tǒng)評價(jià)脫細(xì)胞神經(jīng)支架聯(lián)合間充質(zhì)干細(xì)胞或許旺細(xì)胞移植修復(fù)大鼠坐骨神經(jīng)缺損的療效。方法:檢索PubM ed、The Cochrane Library、EMbase、CNKI、WanF ang和VIP數(shù)據(jù)庫,查閱關(guān)于脫細(xì)胞神經(jīng)支架聯(lián)合間充質(zhì)干細(xì)胞或許旺細(xì)胞修復(fù)大鼠坐骨神經(jīng)缺損的隨機(jī)對照實(shí)驗(yàn),檢索時限均為建庫至2016年7月。由3名研究員按納入和排除標(biāo)準(zhǔn)獨(dú)立篩選文獻(xiàn)、提取數(shù)據(jù)和評價(jià)文獻(xiàn)的方法學(xué)質(zhì)量,采用Review Manger5.3軟件進(jìn)行meta分析。結(jié)果與結(jié)論:最終10篇文獻(xiàn)納入研究,共計(jì)252只大鼠。Meta分析結(jié)果顯示:(1)脫細(xì)胞神經(jīng)支架聯(lián)合間充質(zhì)干細(xì)胞或許旺細(xì)胞組的坐骨神經(jīng)功能指數(shù)均優(yōu)于單純脫細(xì)胞神經(jīng)支架組: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)術(shù)后12周脫細(xì)胞神經(jīng)支架聯(lián)合間充質(zhì)干細(xì)胞或許旺細(xì)胞組神經(jīng)傳導(dǎo)速度、潛伏期、振幅優(yōu)于脫細(xì)胞神經(jīng)支架組:神經(jīng)傳導(dǎo)速度[SMD=1.39,95%CI(0.99,1.78),P0.000 01],潛伏期[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)脫細(xì)胞神經(jīng)支架聯(lián)合間充質(zhì)干細(xì)胞或許旺細(xì)胞組髓鞘厚度均優(yōu)于單純脫細(xì)胞神經(jīng)支架組:術(shù)后8周髓鞘厚度[MD=0.14,95%CI(0.07,0.21),P0.000 1],術(shù)后12周髓鞘厚度[SMD=1.85,95%CI(1.63,2.08),P0.000 01],術(shù)后12周有髓神經(jīng)纖維數(shù)[SMD=3.59,95%CI(2.63,4.55),P0.000 01];(4)術(shù)后8周脫細(xì)胞神經(jīng)支架聯(lián)合間充質(zhì)干細(xì)胞或許旺細(xì)胞組腓腸肌濕重優(yōu)于單純脫細(xì)胞神經(jīng)支架組[SMD=4.22,95%CI(2.40,6.03),P0.000 01];(5)當(dāng)前證據(jù)表明,脫細(xì)胞神經(jīng)支架聯(lián)合間充質(zhì)干細(xì)胞或許旺細(xì)胞治療大鼠坐骨神經(jīng)缺損較單純脫細(xì)胞神經(jīng)支架更有助于神經(jīng)再生和功能恢復(fù)。受納入文獻(xiàn)質(zhì)量的限制,以上結(jié)論需更高質(zhì)量、更大樣本的隨機(jī)對照實(shí)驗(yàn)加以驗(yàn)證。
[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.
【作者單位】： 西南醫(yī)科大學(xué)附屬醫(yī)院骨與關(guān)節(jié)外科;西南醫(yī)科大學(xué);
【基金】：四川省科技廳項(xiàng)目(2014JY0248)~~
【分類號】：R318.08;R688
【正文快照】： 0引言Introduction細(xì)胞等[6]。在神經(jīng)缺損修復(fù)過程中,種子細(xì)胞能夠促進(jìn)有周圍神經(jīng)缺損是臨床常見病、多發(fā)病,其預(yù)后不佳,髓神經(jīng)纖維、軸突的再生,同時能分泌大量細(xì)胞生長因子,有較高的致殘率[1]。學(xué)者一直致力尋求神經(jīng)的理想橋接物,改善神經(jīng)修復(fù)的微環(huán)境[7]。目前國內(nèi)外已有較

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