经皮穿刺经心外膜骨髓单个核细胞移植治疗犬严重缺血性心力衰竭  

Percutaneous transextracardial autologous mononuclear bone marrow cell transplantation for severe ischemic heart failure in dog models

作　　者：高连如[1] 王志国[1] 贺声[2] 张宁坤[1] 朱智明[1] 张云山[2] 费宇行[1] 徐洪涛[1] 丁青艾[3] 杨晔[1] 

机构地区：[1]海军总医院心血管内科,北京100037 [2]海军总医院超声科 [3]海军后勤部卫生部,北京100037

出　　处：《第二军医大学学报》2004年第9期940-944,共5页Academic Journal of Second Military Medical University

基　　金：海军科研基金 (0 0 - 332 2 )

摘　　要：目的 :探讨超声引导下 ,在犬缺血性心力衰竭模型经皮穿刺心外膜下心肌自体骨髓单个核细胞移植 ,修复心肌、再生血管、改善心功能的可能性、安全性及效果。 方法 :成年雄性家犬 ,体质量 2 0～ 30 kg,经皮穿刺球囊封堵前降支建立犬心肌梗死模型手术后 10 d,行超声心动图检查确立 EF<4 0 %为严重缺血性心力衰竭 (共 14条 )。随机实验分组 :细胞移植组 (n=6 )及生理盐水注入组 (对照组 ,n=8)。细胞移植术前 1d分离骨髓单个核细胞 ,以 DAPI标记。2 3G超声引导穿刺针尾部连接电极 ,穿刺入心外膜下心肌 ,监测电极显示 ST段抬高 ,即注入细胞悬液 1.3× 10 6 / ml,改变方向 ,每一点分别注射 0 .2 m l,共 10点。于术前及术后 3个月行超声心动图及组织学检查。结果 :荧光显微镜下可见到大量新生细胞 ,并可见发出绿色荧光的丝状肌丝肌管。光镜下见大量移植的单个核细胞生长 ,移植细胞间及与宿主细胞间均有闰盘连结。细胞移植组心肌梗死区域肉眼可见大量血管 ,小血管数量明显增加 ,心功能明显改善 ,与术前相比 ,每博输出量增加 16 .7m l,EF增加 14 .7% ,左室内径缩小 6 %。而对照组 3个月后 ,梗死区室壁变薄 ,仅见纤维瘢痕组织 ,心腔扩大 ,心功能明显恶化。移植细胞组术中及术后均安全。结论Objective:To investigate the possibility, safety, and effects of repairing infarcted myocardium and angiogenesis with autologous mononuclear bone marrow cells (MBMC) transplantation by echocardiography-guided percutaneous trans-extracardial injection in dogs with severe ischemic heart failure. Methods: Permanent left anterior descendant coronary arteries occlusion was performed in 20 male dogs by balloon to establish ischemic heart failure and extensive myocardial infarction(MI) models. Ten days after MI, echocardiography was performed and EF <40% was considered as severe ischemic heart failure models. Fourteen dogs were divided into 2 groups: cell transplantation group (n=6) and control group(n=8). One day before cell transplantation, MBMC were harvested, isolated, washed, labelled with 4',6-dimidino-2-phenylindone(DAPI). Echocardiography guiding was used to identify infarcted myocardium area percutaneous trans-extracardial injection with 23G ultrasonically guided needle. Control group was injected with saline only (10 injections of 0.2 ml each). Echocardiography study was performed before and 3 months after cells graft. Results: Fluorescent labelled MBMC with green color were found in cell transplantation group 3 months later, but not in control group. Light microscopy revealed the presences of engrafted MBMC and the presence of nascent intercalated disks connecting the engrafted cell and the host myocardium. Many new blood vessels were formed in the infarct-bed. There was a significant improvement in cardiac function. Compared with those before cells transplantation, the strove volume increased by 16.7 ml, ejection fraction increased by 14.7%, and left ventricular diameter decreased by 6%.Conclusion:It is feasible, safe, and effective to use echocardiography-guided percuteneous trans-extracardial injection of MBMC in prepairing infarted myocardium, which might provide a new approach for treatment of severe ischemic heart failure patients who are not suitable for percutaneous coronary intervention and bypass s

关 键 词：骨髓单个核细胞 细胞移植 缺血性心力衰竭 经心外膜 

分 类 号：R541.6[医药卫生—心血管疾病]