作　　者： (向飞帆）; (阳运康）; (谭小琦）; (魏代清）; (杨琨）; (孙远林）; (周举）;

机构地区： 西南医科大学附属医院骨与关节外科,四川省泸州市646000

出　　处： 《中国组织工程研究》 2017年第22期3602-3608,共7页

摘　　要： 背景:研究表明,脱细胞神经支架不仅具有天然神经的空间三维结构,而且具有低免疫原性,但对于长段神经缺损的修复效果仍不理想。为此,有学者将脱细胞神经支架复合种子细胞构建组织工程神经,以提高其治疗效果。目的:系统评价脱细胞神经支架联合间充质干细胞或许旺细胞移植修复大鼠坐骨神经缺损的疗效。方法:检索PubM ed、The Cochrane Library、EMbase、CNKI、WanF ang和VIP数据库,查阅关于脱细胞神经支架联合间充质干细胞或许旺细胞修复大鼠坐骨神经缺损的随机对照实验,检索时限均为建库至2016年7月。由3名研究员按纳入和排除标准独立筛选文献、提取数据和评价文献的方法学质量,采用Review Manger5.3软件进行meta分析。结果与结论:最终10篇文献纳入研究,共计252只大鼠。Meta分析结果显示:(1)脱细胞神经支架联合间充质干细胞或许旺细胞组的坐骨神经功能指数均优于单纯脱细胞神经支架组:2周[SMD=2.73,95%CI(1.92,3.54),P<0.000 01],4周[SMD=4.57,95%CI(3.43,5.70),P<0.000 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),P<0.000 01];(2)术后12周脱细胞神经支架联合间充质干细胞或许旺细胞组神经传导速度、潜伏期、振幅优于脱细胞神经支架组:神经传导速度[SMD=1.39,95%CI(0.99,1.78),P<0.000 01],潜伏期[MD=-0.98,95%CI(-1.19,-0.76),P<0.000 01],振幅[SMD=1.23,95%CI(0.62,1.85),P<0.000 1];(3)脱细胞神经支架联合间充质干细胞或许旺细胞组髓鞘厚度均优于单纯脱细胞神经支架组:术后8周髓鞘厚度[MD=0.14,95%CI(0.07,0.21),P<0.000 1],术后12周髓鞘厚度[SMD=1.85,95%CI(1.63,2.08),P<0.000 01],术后12周有髓神经纤维数[SMD=3.59,95%CI(2.63,4.55),P<0.000 01];(4)术后8周脱细胞神经支架联合间充质干细胞或许旺细胞组腓肠肌湿重优于单纯脱细胞神经支架组[SMD=4.22,95%CI(2.40,6.03),P<0.000 01];(5)当前证据表明,脱细胞神经支架联合间充质干细胞� BACKGROUND： Acellular nerve scaffolds have the three-dimensional structure of natural nerves and low immunogenicity, but their effect on long nerve defects is still not ideal. Therefore, it is necessary to construct tissue- engineered nerve using acellular nerve and seed cells in order to improve the therapeutic effect. OBJECTIVE： To systemically review the efficacy of combination of acellular nerve grafts （ANGs） and mesenchymal stem cells （MSCs） or Schwann cells （SCs） transplantation in the treatment of sciatic nerve defects in a rat model. METHODS： Randomized controlled trials （RCTs） about the effects of combination of ANGs and MSCs or SCs transplantation for sciatic nerve defects in rats were searched in PubMed, The Cochrane Library, EMbase, CNKI, WanFang and VIP from inception to July 2016. Three reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then, a Meta-analysis was performed using Review Manger5.3 software. RESULTS AND CONCLUSION： A total of 10 RCTs involving 252 rats were included. The results of meta-analysis showed that： compared with the control group （simple acellular nerve scaffold group）, the sciatic functional index （SFI） of the combined group （combination of ANGs and MSCs or SCs transplantation） were superior at 2 weeks [SMD=2.73, 95% CI （1.92, 3.45）, P 〈 0.000 01], 4 weeks [SMD=4.57, 95% CI （3.43, 5.70）, P 〈 0.000 01], 6 weeks [SMD=1.62, 95% CI （0.18,3.06）, P=0.03], 8 weeks [SMD=4.90, 95% CI （2.96, 6.84）, P 〈 0.000 01] after surgery. The nerve conduction velocity [SMD=1.39, 95% CI （0.99, 1.78）, P 〈 0.000 01）, latency period （MD=-0.98, 95% CI （-1.19, -0.76）, P 〈 0.000 01], and amplitude [SMD=1.23, 95% CI （0.62, 1.85）, P 〈 0.000 1] were superior at 12 weeks after surgery. The myelin sheath thickness was superior at 8 weeks [MD=0.14, 95% CI （0.07, 0.21）, P 〈 0.000 1], 12 weeks [SMD=1.85, 95% CI �

关 键 词： 生物材料 材料相容性 周围神经缺损 骨髓间充质干细胞 脂肪间充质干细胞 许旺细胞 脱细胞神经支架 组织工程神经 疗效 大鼠 分析