经颈内静脉肝内门体分流联合脐带血干细胞灌注移植治疗肝硬化临床分析  

The analysis of transjugular intrahepatic portosystemic shunt togetherwith umbilici cord blood stem cell transplantation in treatment of hepatocirrhosis

作　　者：杨彦林[1] 王树平[1] 李华[1] 韩东亮[1] 付广印[1] 吴国良[1] 潘江浩[1] 王东[1] 杨占辉[1] 

机构地区：[1]河北省衡水市哈励逊国际和平医院,053000

出　　处：《环球中医药》2013年第S2期6-8,共3页Global Traditional Chinese Medicine

基　　金：河北省医学科学研究重点课题计划项目(20110647)

摘　　要：目的探讨和评价经颈内静脉肝内门体分流术联合脐带血干细胞经肝动脉灌注移植治疗肝硬化的有效性和安全性。方法 50例失代偿期肝硬化患者,随机分为治疗组及对照组:治疗组30例,在内科治疗基础上采用TIPS联合脐带血干细胞移植。对照组20例,仅采用内科药物治疗。两组性别、年龄、病理构成及Child-Pugh分级均具有同质性。术前1周、术后1月及术后3月观察2组患者丙氨酸氨基转移酶(ALT)、前白蛋白(PA)、总胆红素(TBIL)水平变化、临床症状改善及并发症情况。结果 TIPS手术及干细胞移植顺利,2组患者术前ALT、PA、TB均无明显差异;对照组药物治疗前后肝功能无特殊变化;治疗组患者术后3月时ALT(36.47±3.53U/L)较术前减低,PA(86.26±12.44mg/L)较术前明显升高(P<0.05),但仍低于正常下限(100mg/L)。术后1月(76.67%VS 35.00%)、3月(86.67%VS 40.00%)治疗组总有效率均优于对照组(P<0.01)。治疗组术后肝性脑病1例,穿刺点周围血肿2例,干细胞移植后低热2例,均经对症治疗后好转。术后3月肝胆CT检查分流道通畅,未见占位病变。结论 TIPS联合干细胞移植治疗终末期肝病在降低门脉压的同时改善了肝脏功能,操作安全可靠、近期效果确实。如何提高干细胞定植分化的几率,最佳的移植途径,是否需多次移植,肝功能改善的具体机制及其远期安全性仍需我们进一步研究。Objective To evaluate the efficacy and safety of Tansjugular Intrahepatic Portosystemic Shunt (TIPS) togetherwith human um-bilic cord blood stem cell transplantation through hepatic artery in treatment of patients with liver cirrhosis .Methods 50 patients were divided into treatment group (30 patients) and control group (20 patients) randomly .Sex and age structure ,pathological type and Child-Pugh grading showed no different between 2 groups .Control group only used drugs ,while the treatment group adopted TIPS and umbilic cord blood stem cell transplan-tation besides drugs .Alanine aminotransferase (ALT) ,prealbumin (PA) and total bilirubin (TIBL) were measured and analyzed in each group at pre-operation ,1 month and 3 months after transplantation .Clinical symptoms and adverse reaction was observed also .Results TIPS and transla-tion was carried out successfully .There had no significant difference of ALT ,PA and TIBL between 2 groups pre-operation .It also showed no sig-nificant change in the control group .Yet the level of ALT decreased while PA increased significantly at 3 months after transplantation(P<0.05) in treatment group .But PA(86.26 ± 12.44mg/L)was still subaverage(lower limit 100mg/L) .The overall response rate(OR) between the treat-ment group and the control group was 76.67% VS 35.00% at 1 month and 86.67% VS 40.00% at 3 months after transplantation(P<0.01) .He-patic encephalopathy occurred in 1 patient ,hematoma around puncture site was found in 2 patients ,and 2 patients got low fever after transplanta-tion .All those patients mended after symptomatic treatment .Upper gastrointestinal hemorrhage was found or reappeared in 5 patients in control group ,while none was found in the treatment group .No occupying lesions was detected in liver by CT at 3 month post-transplantation and no stent was obstructed .Conclusion TIPS togetherwith human umbilic cord blood stem cell transplantation could decrease the pressure of portal veins and improve hepatic function in patients with cirrhosis .It was a safe

关 键 词：经颈内静脉肝内门体分流术 人脐带血干细胞 肝硬化 干细胞移植 介入放射学 

分 类 号：R657.31[医药卫生—外科学]