目的:评价不同来源的干细胞治疗对踝肱指数的影响。伤口闭合百分比,和伤口闭合时间在治疗糖尿病足溃疡(DFU)。
方法:在PubMed,Embase,Cochrane图书馆的受控试验中央登记册,和WebofScience,延续至2023年6月29日。使用Cochrane的偏倚风险评估工具(RoB2.0)进行质量评估。采用贝叶斯方法,统计计算是用JAGS软件执行的,利用gemtc0.8-2和rjags4-10库,在R环境4.1.2中。纳入的干预措施来自外周血,骨髓,胎盘,脐带血,脂肪组织,或其他人。
结果:初步搜索确定了2286篇文章,其中23项随机对照试验符合纳入标准并最终纳入.分析结果表明,与标准治疗相比,来自脐带的间充质干细胞(HUCMSC)导致DFU患者的踝肱指数显着提高(MD:0.2;95%CI[0.01,0.36])。HUCMSCs被发现是增强踝臂指数的最佳治疗方法(SUCRA=82.7%)。对伤口闭合百分比的研究表明,与富含血小板的血浆(PRP)相比,经处理的微血管组织(PMVT),外周血干细胞(PBSC),微粉碎脂肪组织(MFAT),自体骨髓干细胞治疗(ABMSCT),脂肪干细胞(ASCs),和脱水的人脐带同种异体移植物(EpiCord),活血生肌汤(HXSJD)+ABMSCT(H_Group_homaticality)显着提高了DFU患者的伤口闭合率(P<0.05)。根据SUCRA排名,HXSJD+ABMSCT是增加伤口闭合百分比的最佳治疗方法(SUCRA=93.8%)。
结论:本研究采用网络荟萃分析方法,结合直接和间接比较,分析最新的临床数据,得出结论,脐带间充质干细胞和HXSJD+自体骨髓造血干细胞联合治疗作为DFU的辅助治疗可能有有益效果。未来的研究需要关注这一点。
OBJECTIVE: To evaluate the efficacy of stem cell therapy from different sources on the ankle-brachial index, wound closure percentage, and wound closure time in the treatment of diabetic foot ulcers (DFUs).
METHODS: A literature search was conducted in PubMed, Embase, Cochrane Library\'s Central Register of Controlled Trials, and Web of Science, extending through June 29, 2023. Quality evaluation was done using the Cochrane\'s bias risk assessment tool (RoB 2.0). Employing a Bayesian approach, the statistical computations was executed with the JAGS software, leveraging the gemtc 0.8-2 and rjags 4-10 libraries, within the R environment 4.1.2. The included interventions came from peripheral blood, bone marrow, placenta, umbilical cord blood, adipose tissue, or others.
RESULTS: A preliminary search identified 2286 articles, of which 23 randomized controlled trials met the inclusion criteria and were ultimately included. The analysis findings indicated that mesenchymal stem cells derived from the umbilical cord (HUCMSCs) led to a notable enhanced the ankle-brachial index in patients with DFUs compared to standard treatment (MD: 0.2; 95% CI [0.01, 0.36]). HUCMSCs were found to be the optimal therapeutic approach for enhancing the ankle-brachial index (SUCRA = 82.7%). Research on the wound closure percentage revealed that compared to platelet-rich plasma (PRP), processed microvascular tissue (PMVT), peripheral blood stem cells (PBSCs), microfragmented adipose tissue (MFAT), autologous bone marrow-derived stem cell therapy (ABMSCT), adipose-derived stem cells (ASCs), and dehydrated human umbilical cord allograft (EpiCord), Huoxue Shengji Decoction (HXSJD) + ABMSCT (H_Group_hematopoietic) significantly increased the wound closure percentage in DFU patients (P < 0.05). According to the SUCRA ranking, HXSJD + ABMSCT was the best therapeutic method to increase the percentage of wound closure (SUCRA = 93.8%).
CONCLUSIONS: This study employed a network meta-analysis method, combining direct and indirect comparisons, to analyze the latest clinical data and concluded that umbilical cord mesenchymal stem cells and the combination of HXSJD + autologous bone marrow hematopoietic stem cell treatment as adjunctive therapies for DFUs may have beneficial effects. Future research needs to focus on this.