自体骨髓单个核细胞经冠状动脉移植对心肌梗死患者心脏整体功能及局部心肌运动的影响  

Effect of intracoronary transplantation of bone marrow mononuclear cells on cardiac function and regional myocardial movement of patients with acute myocardial infarction

作　　者：于玲范[1] 吕勃[1] 于玲媛 李天发[3] 陈延军[3] 刘文华[1] 姜雪松[1] 田家玮[4] 张淑云[5] 

机构地区：[1]哈尔滨医科大学附属第二医院心外ICU,黑龙江省哈尔滨市150086 [2]大庆职工教育学院医技教研室,黑龙江省大庆市163000 [3]哈尔滨医科大学附属第二医院心内科,黑龙江省哈尔滨市150086 [4]哈尔滨医科大学附属第二医院彩色超声科,黑龙江省哈尔滨市150086 [5]哈尔滨医科大学附属第二医院分子试验中心,黑龙江省哈尔滨市150086

出　　处：《中国临床康复》2005年第26期71-74,共4页Chinese Journal of Clinical Rehabilitation

基　　金：黑龙江省科技计划项目(GC04C30103)~~

摘　　要：目的:采用经冠状动脉途径进行自体骨髓单个核细胞移植治疗心肌梗死,通过组织多普勒多巴酚丁胺负荷超声心动图检查,观察移植前后患者整体及坏死局部心脏功能变化,以了解自体骨髓单个核细胞介入移植治疗心肌梗死的可行性及有效性。方法:①选择2003-09/2004-03在哈尔滨医科大学附属第二医院心内科住院的急性透壁性心肌梗死患者68例,随机选择其中10例进行自体骨髓单个核细胞经冠状动脉移植。均为男性,平均年龄(52±10)岁。术前签署知情同意书并同意术后随访。②骨髓单个核细胞的获取:介入手术当天,约于细胞注射前3h进行。选择髂后上棘行骨髓穿刺术,抽取骨髓60～80mL,离心后,取单个核细胞层配成骨髓单个核细胞悬液。所获取的骨髓单个核细胞平均为(7.67±1.34)×109L-1,细菌和真菌培养均为阴性结果。③骨髓单个核细胞经冠状动脉移植:细胞移植于急性心肌梗死后后第7～14天进行。将直径2.5mm的OTW球囊置于心肌梗死边界区(血管堵塞部位),10min内缓慢注入骨髓单个核细胞悬液10mL。④移植后心脏整体功能和局部功能评估;组织多普勒超声心动图检查:分别于单个核细胞移植术前及术后7,30,90及180d行组织多普勒多巴酚丁胺负荷超声心动图检查。整体心功能测定:左室长轴取二尖瓣水平M型,分别测左室舒张末期内径,左室收缩末期内径、二尖瓣侧环心肌舒张早期峰值运动速度与舒张晚期峰值运动速度比值;并计算出每搏输出量、左室短轴缩短率等。Simpson法测量左室射血分数。了解坏死局部心肌运动情况:采用组织多普勒小剂量多巴酚丁胺负荷试验测量坏死局部心肌运动,在10μg/(kg·min)时心肌运动改善最明显。于静息状态、各剂量输注3min后和终止多巴酚丁胺输注5min后,连续监测超声心动图,分别取心尖四腔心、心尖两腔心、心尖长轴切面,将每个切面分成3个AIM： Patients with acute myocardial infarction are treated with autologous bone marrow mononuclear cells （BMMNCs） which are transplanted by coronary artery. After the procedure, the global and the local heart function are evaluated by using echocardiography and tissue Doppler image in order to identify the safety and feasibility of the new treatment just mentioned. METHODS： ① Among 68 patients with reperfused acute myocardial infarction （AMI）, 10 males with the average of （52±10） years old were randomly selected from the Second Hospital Affiliated to Harbin Medical University from September 2003 to March 2004. Each of them was given autologous BMMNCs transplantation by coronary artery. All the 10 patients were briefed in detail about the procedure of BMMNCs transplantation. Written informed consent was obtained from each one. ② BMMNCs aspiration and isolation： Approximately 3 hours before the cell injection, bone marrow （60-80 mL） was aspired under local anesthesia from the posterior iliac crest using heparinized syringes. BMMNCs were isolated by density gradient centrifugation after adding an equal volume of lymphocyter separation medium. The mean number of BMMNCs was （7.67±1.34） ×10^9L^-1. Bacterial and fungal cultures of the clinically used cell preparations were proved negative.③ lntracoronary transplantation of BMMNCs： A mean of 7-14 days after the AMI, an over-the-wire balloon catheter oversized by 2.5 mm was advanced into the stent previously implanted during the acute reperfusion. To allow for adhesion and potential transmigration of the infused cells through the catheter, the intracoronary transplantation of the 10 mL cell suspension was slowly performed within 10 minutes. ④ Echocardiography （DSE）： Examinations were performed at a day before BMMNCs transplantation; 7 days, 30 days, 90 days, 180 days after transplantation to determine the global and regional heart function. The global heart function： Left ventricular （LV） long-axis and M-mode were scanned

关 键 词：干细胞 骨髓移植 移植 自体 心肌梗塞/治疗 自体骨髓单个核细胞 心肌梗死患者 冠状动脉移植 心肌运动 局部功能 心脏功能 

分 类 号：R746.4[医药卫生—神经病学与精神病学] R473.5[医药卫生—临床医学]