| Objective: To systematically evaluating the efficacy and safety of autologous bone marrow stem cells(BMSCs)transplanted via hepatic artery treat decompensated cirrhosis,which provide reference for the treatment of the decompensation of liver cirrhosis.Methods: Computer retrieves the database for nearly a decade including three Chinese database: Wan FangDate,VIP information network,China National Knowledge Infrastructure(CKNI)and two foreign language database: the Cochrane Library,PubMed.Manual retrieve the important journals associated with liver disease nearly 10 years,and filtrate the literature according to the research needs which combing inclusion and exclusion criteria,analysis data by Revman5.3,quality rating by GRADE.Results:There are 15 journal literature meet the inclusion requirements in this evaluation,time from 2010 to 2016,include 1040 cases in total.The quality evaluation of evidence contains 3 articles "senior",8 "intermediate",4 "lower",mainly affecting the quality of the article in hidden,blinded,surgical and non-surgical.Total evaluation analysis shows that the curative effect of autologous bone marrow stem cell transplantation therapy in patients with decompensated cirrhosis is superior to conventional western medicine treatment.On the improvement of the symptoms,improve ascites(MD=1.92,95%CI(1.43-2.57),P<0.0001),poor appetite reduce aspects(MD=1.77,95% CI1.41-2.23,P<0.00001),lack of power to improve(MD=1.74,95%CI(1.39-2.17),P<0.00001),abdominal distension,reduce aspects(MD=1.86,95%CI(1.45-2.37),P<0.00001),stem cell transplantation in treatment group compared with conven tional western medicine control group has statistical significance,whcih instructions that autologous bone marrow stem cells transplantation therapy in improving symptoms of decompensated cirrhosis is superior to the conventional western medicine treatment.On the Serological indicators,propagated(MD=5.22,95%CI(2.40-8.04),P=0.0003),the ALT(MD=-17.8,95%CI(-30.8--4.8),P=0.007<0.01),TBIL(MD=-11.77,95%CI(-17.85--5.7),P=0.0001<0.01),PT(MD=-4.33,95%CI(-8.58--0.08),P=0.05),stem cell transplantation in treatment group compared with conventional western medicine control group has statistical significance,whcih instructions that autologous bone marrow stem cell transplantation therapy in improving serology of decompensated cirrhosis of liver function is superior to western medicine routine control treatment;While the PTA(MD=19.31,95%CI(-2.72-41.34),P=0.09>0.05)of stem cell transplantation in treatment group compared with routine western medicine control group on the improvement of the prothrombin time activity has no statistical significance,effect were equal.The comprehensive score on the liver,Child-Pugh score(MD=-1.44,95%CI(-1.68--1.21),P<0.00001),the MELD score(=-4.50,95%CI(-8.13--0.86),P=0.02<0.05),two score indicates that stem cell transplantation in treatment group compared with conventional western medicine control group has statistical significance,whcih instructions that stem cells transplantation has better MELD score than the conventional western medicine treatment,but the sample size is too small and need a larger one to further proof.Adverse reactions is difficult to assess due to lacking of statistical significance,so far as the included literatures shows autologous bone marrow stem cell transplantation therapy with less adverse reaction and high safety.Conclusions:Meta analysis evaluation indicated that stem cell transplant tation group in clinical symptoms,liver function,blood coagulation function,Child-Pugh score,the short-term efficacy of MELD score(1 to 6 months)were better than the control group;and with less adverse reaction,high safety,it is worth to promoting application.But the reliability of the evaluation conclusion is affected by the article quality and the sample size,which should be treated with caution.Most of the stem cell transplant patients in our country are liver cirrhosis caused by viral hepatitis,who have been to or on going to an antiviral therapy.liver function in patients more better,then the curative effect is more better.The recommendations for autologous bone marrow stem cell transplants are as follows: the amount of bone marrow collected for 100-200 ml,number of mononuclear cells after purification of about 108-1010/ml,stem cell detection of 106-109/ml,guarantee survival rate reached 75%,4 ? refrigerated up to 4 hours,preoperative gived promote liver or g-csf auxiliary,hepatic artery interventional transplantation would have better curative effect,postoperation gived traditional Chinese medicine(TCM)or growth factor to promote stem cell homing differentiation. |
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