背景:自体造血干细胞移植(HSCT)被认为是高活性多发性硬化症(MS)的有效治疗方法。迄今为止,大多数研究主要集中在疾病结局指标上,尽管神经心理症状对MS患者的生活质量有显著影响。当前的系统评价旨在检查MS的HSCT是否影响神经心理学结果测量,如认知,疲劳,心情,和生活质量。
方法:该评论已在国际前瞻性系统评论注册(PROSPERO,ID:CRD42023474214)。在六个数据库中进行了系统搜索(PsycINFO,PubMed,Embase,Scopus,CINAHL和WebofScience)基于以下纳入标准:(i)在英文同行评审期刊上发表;(ii)对患有MS的成年人进行纵向研究(iii)使用标准化措施评估HSCT前后至少一种神经心理学结果。使用国家心脏评估偏倚风险,肺和血液研究所(NHLBI)质量评估工具。使用叙述性综合来呈现结果。
结果:11项研究纳入本综述。确定了HSCT后生活质量的长期改善。在认知和疲劳方面,证据好坏参半,确定了HSCT后的一些改进。观察到短期HSCT后认知能力下降。HSCT后未发现情绪变化。基于偏差风险,提出了谨慎解释这些结果的参数。基于偏差风险,提出了谨慎解释这些结果的参数。讨论了证据的局限性,这种混杂的变量和缺乏统计能力。
结论:HSCT对MS神经心理学结果影响的证据基础有限。需要进一步的研究来增进理解,以促进临床医生和患者对MS的HSCT治疗的理解。
BACKGROUND: Autologous haematopoietic stem cell transplant (HSCT) is considered an effective treatment for highly active multiple sclerosis (MS). To date, most research has focused primarily on disease outcome measures, despite the significant impact of neuropsychological symptoms on MS patients\' quality of life. The current systematic review aimed to examine whether HSCT for MS impacts neuropsychological outcome measures such as cognition, fatigue, mood, and quality of life.
METHODS: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO, ID: CRD42023474214). Systematic searches were carried out in six databases (PsycINFO, PubMed, Embase, Scopus, CINAHL and Web of Science) based on the following inclusion criteria: (i) published in peer-reviewed journals in English; (ii) longitudinal studies of adults with MS (iii) at least one neuropsychological outcome was assessed pre- and post-HSCT using standardised measures. Risk of bias was assessed using the National Heart, Lung and Blood Institute (NHLBI) quality assessment tools. A narrative synthesis was used to present results.
RESULTS: Eleven studies were included in the review. Long-term improvements in quality of life post-HSCT were identified. In terms of cognition and fatigue, the evidence was mixed, with some post-HSCT improvements identified. Decline in cognitive performance in the short-term post-HSCT was observed. No changes in mood were identified post-HSCT. Arguments for interpreting these results with caution are presented based on risk of bias. Arguments for interpreting these results with caution are presented based on risk of bias. Limitations of the evidence are discussed, such confounding variables and lack of statistical power.
CONCLUSIONS: The evidence base for the impact of HSCT for MS on neuropsychological outcomes is limited. Further research is required to progress understanding to facilitate clinician and patient understanding of HSCT treatment for MS.