中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (6): 1096-1106.doi: 10.4103/1673-5374.233454

• 原著:脊髓损伤修复保护与再生 • 上一篇    下一篇

脊髓切开术可促进脊髓损伤大鼠运动功能恢复：6项随机对照动物试验的meta分析

  

  • 收稿日期:2018-04-25 出版日期:2018-06-15 发布日期:2018-06-15
  • 基金资助:

    中国中央公共研究所基础科学研究特别基金（2015CZ-6，2016CZ-4）；北京脑疾病研究所项目（201601）

Myelotomy promotes locomotor recovery in rats subjected to spinal cord injury: a meta-analysis of six randomized controlled trials

Chuan Qin1, 2, 3, Wen-Hao Zhang1, 2, 3, De-Gang Yang1, 2, 3, 5, Ming-Liang Yang1, 2, 3, 4, 5, Liang-Jie Du1, 2, 3, Jian-Jun Li1, 2, 3, 4, 5   

  1. 1 School of Rehabilitation Medicine, Capital Medical University, Beijing, China
    2 Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
    3 Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
    4 China Rehabilitation Science Institute, Beijing, China
    5 Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
  • Received:2018-04-25 Online:2018-06-15 Published:2018-06-15
  • Contact: Jian-Jun Li, crrclijj@163.com.
  • Supported by:

    This work was supported by the Special Fund for Basic Scientific Research of Central Public Research Institutes of China, No.2015CZ-6, 2016CZ-4; a grant from the Beijing Institute for Brain Disorders, No. 201601

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摘要：

目的：评估脊髓切开术对脊髓损伤模型大鼠运功功能的影响。
资料来源：本研究从PubMed, Science Citation Index, Cochrane Library, 中国知网, 万方数据库, 中国生物医学文献数据库以及中国期刊全文数据库进行文献检索。检索主题词为“脊髓切开术(Myelotomy)”，“脊髓损伤(Spinal Cord Injuries)”, “大鼠(Rats)”, “随机对照实验(Randomized controlled trial)” 及相关的所有自由词。检索时间截止到2017年9月。
资料选择：纳入脊髓切开术治疗急性脊髓损伤模型大鼠相关的随机对照动物实验，采用BBB评分作为运动恢复的判定标准。本研究利用Review Manager 软件(版本 5.3.0.)对数据进行处理，利用χ2和I2检验来评估异质性。本研究应用随机效应模型同时进行亚组分析评估异质性来源。
结局评价指标：以损伤后1-6周为观察时间，分别评估各组大鼠BBB评分变化。
结果：本研究通过筛选，共纳入6项动物实验，143只实验大鼠。根据损伤程度(中度或者重度)将分为两个亚组。结果显示：脊髓损伤后观察1-6周，脊髓切开组大鼠的BBB评分和损伤对照组相比出现了升高，且差异有显著性意义(WMD=0.60; 95% CI: 0.23–0.97; P =0.001; WMD=2.10; 95% CI: 1.56–2.64; P < 0.001; WMD=2.65; 95% CI: 1.73–3.57; P < 0.001; WMD=1.66; 95% CI: 0.80–2.52; P < 0.001; WMD=2.09; 95% CI: 0.92–3.26, P<0.001; WMD=2.25; 95%CI: 1.06–3.44, P < 0.001)。其异质性较高(I2=85%; I2=95%; I2=94%;I2=88%;I2=91%;I2=89%)。在中度损伤亚组中，脊髓切开组的BBB评分要高于损伤对照组(WMD=0.91, 95% CI: 0.52–1.3, P < 0.001；WMD=2.10; 95% CI: 1.56–2.64, P < 0.001；WMD=2.65; 95% CI: 1.73–3.57, P < 0.001; WMD=2.50, 95% CI: 1.72–3.28, P < 0.001; WMD=3.29, 95% CI: 2.21–4.38, P < 0.001; WMD=3.27; 95% CI: 2.31–4.23, P < 0.001)。其异质性为中度(I2=48%;I2=46%;I2=42%;I2=43%;I2=49%;I2=49%)。然而，在损伤后第2和3周的重度损伤亚组中，脊髓切开组和损伤对照组的BBB评分差异并无显著性意义(P=0.75; P=0.92)。
结论：截至目前，尚无关于脊髓切开术对脊髓损伤后运动功能恢复的综合性分析，文章是第一篇该领域的meta分析，结果显示脊髓切开术明显地改善了脊髓损伤后大鼠运功功能的恢复，特别是对于中度损伤的大鼠，效果更为显著。

orcid:0000-0002-8441-7537(Jian-Jun Li)

关键词: 脊髓损伤, 脊髓切断术, 运动功能恢复, 大鼠, 康复, 中度损伤, 随机对照试验, 系统综述, Meta分析, 神经再生

Abstract:

OBJECTIVE: To investigate the effects of myelotomy on locomotor recovery in rats subjected to spinal cord injury.
DATA SOURCES: Electronic databases including PubMed, Science Citation Index, Cochrane Library,China National Knowledge Infrastructure, Chinese Journals Full-text Database, China Biology Medicine disc, and Wanfang Database were searched to retrieve related studies published before September 2017.The MeSH terms (the Medical Subject Headings) such as “myelotomy”, “spinal cord injuries”, “rats”, “randomized controlled trial” and all related entry terms were searched.
DATA SELECTION: Randomized controlled trials using myelotomy for the treatment of acute spinal cord injury in rats were included. Basso, Beattie, and Bresnahan scores were adopted as the evaluation method.RevMan Software (version 5.3) was used for data processing. The χ2 and I2 tests were used to assess heterogeneity.Using a random-effects model, a subgroup analysis was conducted to analyze the source of the heterogeneity.
OUTCOME MEASURES: Basso, Beattie, and Bresnahan scores were observed 1–6 weeks after spinal cord injury.
RESULTS: Six animal trials were included, using a total of 143 lab rats. The included trials were divided into two subgroups by injury degrees (moderate or severe). The pooled results showed that, 1–6 weeks after spinal cord injury, the overall Basso, Beattie, and Bresnahan score was significantly higher in the myelotomy group than in the contusion group (weighted mean difference (WMD) = 0.60; 95% confidence interval(CI): 0.23–0.97; P = 0.001; WMD = 2.10; 95% CI: 1.56–2.64; P < 0.001; WMD = 2.65; 95% CI: 1.73–3.57; P < 0.001; WMD = 1.66; 95% CI: 0.80–2.52; P < 0.001; WMD = 2.09; 95% CI: 0.92–3.26, P < 0.001; WMD = 2.25; 95% CI: 1.06–3.44, P < 0.001). The overall heterogeneity was high (I2 = 85%; I2 = 95%; I2 = 94%; I2 = 88%; I2 = 91%; I2 = 89%). The results in the moderate injury subgroup showed that Basso, Beattie, and Bresnahan scores were significantly higher in the myelotomy group than in the contusion group (WMD = 0.91, 95% CI: 0.52–1.3, P < 0.001; WMD = 2.10; 95% CI: 1.56–2.64, P < 0.001; WMD = 2.65; 95% CI: 1.73–3.57, P < 0.001; WMD = 2.50, 95% CI: 1.72–3.28, P < 0.001; WMD = 3.29, 95% CI: 2.21–4.38, P < 0.001; WMD = 3.27; 95% CI: 2.31–4.23, P < 0.001). The relevant heterogeneity was low. However, there were no significant differences in Basso, Beattie, and Bresnahan scores between the myelotomy and contusion groups in the severe injury subgroup at 2 and 3 weeks after the injury (P = 0.75; P = 0.92).
CONCLUSION: To date, this is the first attempt to summarize the potential effect of myelotomy on locomotor recovery in rats with spinal cord injury. Our findings conclude that myelotomy promotes locomotor recovery in rats with spinal cord injury, especially in those with moderate injury.

Key words: nerve regeneration, spinal cord injury, myelotomy, locomotor recovery, rats, rehabilitation, moderate injury, randomized controlled trials, systematic review, meta-analysis, neural regeneration