Abstract：
Stem cell is considered a potential therapy for treating erectile dysfunction (ED), including diabetic mellitus erectile dysfunction (DMED), which was investigated in some preclinical studies. Several trials introduced stem cell into clinical practice, but divergences emerged.
To further investigate the therapeutic effects of stem cell on DMED in preclinical studies and investigate some possible factors that influence curative effects.
The literature research was conducted in Web of Science and PubMed to retrieve studies utilizing stem cell to treat DMED. Revman 5.3 was used to perform subgroup analysis of intracavernosal pressure/mean artery pressure (ICP/MAP) and structural changes. Publication bias was assessed with Egger\'s test, funnel plot, and sensitivity analysis by Stata 15.0.
The ICP/MAP and structural changes before and after stem cell treatment.
Of 2,115 studies retrieved, 23 studies are eligible. Plus 10 studies from a meta-analysis published in 2016, 33 studies were enrolled. Pooled analysis showed that stem cell ameliorates damaged ICP/MAP (WMD 0.26; 95% CI 0.23-0.29; P < .001) and structural changes induced by diabetes. Subgroup analysis indicated that adipose-derived mesenchymal stem cell (ADSC) may have better efficacy than bone marrow-derived mesenchymal stem cell (BMSC) (χ2= 4.21, P = .04; ADSC WMD 0.28, 95% CI [0.24-0.32] vs BMSC WMD 0.22 95% CI [0.17-0.26]). Transplantation type, diabetes type, and cell number make no difference to curative effects. Gene modification and therapy combination proved promising in improving the therapeutic effects of stem cell.
The evidence reminded that ADSC may be prior to BMSC in clinical trials and autotransplantation is probably not compulsory in the clinical practice of stem cell.
The study number and sample size are large enough. However, high degree of heterogeneity remains after subgroup analysis.
This meta-analysis suggests the efficacy of stem cell therapy for DMED and the possible superiority of ADSC over BMSC in erection restoration and structure renovation.
To further investigate the therapeutic effects of stem cell on DMED in preclinical studies and investigate some possible factors that influence curative effects.
The literature research was conducted in Web of Science and PubMed to retrieve studies utilizing stem cell to treat DMED. Revman 5.3 was used to perform subgroup analysis of intracavernosal pressure/mean artery pressure (ICP/MAP) and structural changes. Publication bias was assessed with Egger\'s test, funnel plot, and sensitivity analysis by Stata 15.0.
The ICP/MAP and structural changes before and after stem cell treatment.
Of 2,115 studies retrieved, 23 studies are eligible. Plus 10 studies from a meta-analysis published in 2016, 33 studies were enrolled. Pooled analysis showed that stem cell ameliorates damaged ICP/MAP (WMD 0.26; 95% CI 0.23-0.29; P < .001) and structural changes induced by diabetes. Subgroup analysis indicated that adipose-derived mesenchymal stem cell (ADSC) may have better efficacy than bone marrow-derived mesenchymal stem cell (BMSC) (χ2= 4.21, P = .04; ADSC WMD 0.28, 95% CI [0.24-0.32] vs BMSC WMD 0.22 95% CI [0.17-0.26]). Transplantation type, diabetes type, and cell number make no difference to curative effects. Gene modification and therapy combination proved promising in improving the therapeutic effects of stem cell.
The evidence reminded that ADSC may be prior to BMSC in clinical trials and autotransplantation is probably not compulsory in the clinical practice of stem cell.
The study number and sample size are large enough. However, high degree of heterogeneity remains after subgroup analysis.
This meta-analysis suggests the efficacy of stem cell therapy for DMED and the possible superiority of ADSC over BMSC in erection restoration and structure renovation.
摘要：
背景：干细胞被认为是治疗勃起功能障碍（ED）的潜在疗法，包括糖尿病性勃起功能障碍（DMED），在一些临床前研究中进行了调查。几项试验将干细胞引入临床实践，但是分歧出现了。
目的：在临床前研究中进一步研究干细胞对DMED的治疗作用，并探讨影响疗效的一些可能因素。
方法：在WebofScience和PubMed上进行了文献研究，以检索利用干细胞治疗DMED的研究。使用Revman5.3进行海绵体内压/平均动脉压（ICP/MAP）和结构变化的亚组分析。发表偏倚用Egger检验进行评估，漏斗图,用Stata15.0进行敏感性分析。
结果：干细胞处理前后的ICP/MAP和结构变化。
结果：在检索到的2,115项研究中，23项研究符合条件。加上2016年发表的荟萃分析的10项研究，纳入了33项研究。汇总分析表明，干细胞改善了糖尿病引起的ICP/MAP（WMD0.26；95％CI0.23-0.29；P<.001）和结构变化。亚组分析表明，脂肪间充质干细胞（ADSC）可能比骨髓间充质干细胞（BMSC）具有更好的疗效（χ2=4.21，P=.04；ADSCWMD0.28，95％CI[0.24-0.32]vsBMSCWMD0.2295％CI[0.17-0.26]）。移植类型,糖尿病类型,和细胞数量对疗效没有影响。基因修饰和治疗组合在改善干细胞的治疗效果方面被证明是有前途的。
结论：证据提示，在临床试验中，ADSC可能先于BMSC，自体移植在干细胞临床实践中可能不是强制性的。
■研究数量和样本量足够大。然而,亚组分析后仍存在高度异质性。
结论：这项荟萃分析提示干细胞治疗DMED的疗效，以及ADSC在勃起恢复和结构修复方面可能优于BMSC。
目的：在临床前研究中进一步研究干细胞对DMED的治疗作用，并探讨影响疗效的一些可能因素。
方法：在WebofScience和PubMed上进行了文献研究，以检索利用干细胞治疗DMED的研究。使用Revman5.3进行海绵体内压/平均动脉压（ICP/MAP）和结构变化的亚组分析。发表偏倚用Egger检验进行评估，漏斗图,用Stata15.0进行敏感性分析。
结果：干细胞处理前后的ICP/MAP和结构变化。
结果：在检索到的2,115项研究中，23项研究符合条件。加上2016年发表的荟萃分析的10项研究，纳入了33项研究。汇总分析表明，干细胞改善了糖尿病引起的ICP/MAP（WMD0.26；95％CI0.23-0.29；P<.001）和结构变化。亚组分析表明，脂肪间充质干细胞（ADSC）可能比骨髓间充质干细胞（BMSC）具有更好的疗效（χ2=4.21，P=.04；ADSCWMD0.28，95％CI[0.24-0.32]vsBMSCWMD0.2295％CI[0.17-0.26]）。移植类型,糖尿病类型,和细胞数量对疗效没有影响。基因修饰和治疗组合在改善干细胞的治疗效果方面被证明是有前途的。
结论：证据提示，在临床试验中，ADSC可能先于BMSC，自体移植在干细胞临床实践中可能不是强制性的。
■研究数量和样本量足够大。然而,亚组分析后仍存在高度异质性。
结论：这项荟萃分析提示干细胞治疗DMED的疗效，以及ADSC在勃起恢复和结构修复方面可能优于BMSC。
