自体骨髓移植治疗扩张型心肌病并心力衰竭的初步效果(附5例报告)  

Preliminary Treatment Effect of Autologous Bone Marrow Transplantation on Dilated Cardiomyopathy and Heart Failure(5 Cases Report)

作　　者：胡春松[1] 程晓曙[1] 吴清华[1] 吴延庆[1] 石庆芝[2] 李菊香[1] 胡建新[1] 程应樟[1] 苏海[1] 罗伟[1] 

机构地区：[1]330006,南昌,江西医学院心血管病研究所,江西医学院二附院心内科 [2]江西医学院二附院血液科

出　　处：《中国分子心脏病学杂志》2003年第1期14-17,共4页Molecular Cardiology of China

基　　金：江西省卫生基金(2001)资助

摘　　要：目的观察自体骨髓移植(ABMT)治疗扩张型心肌病并心力衰竭的初步效果.方法1)临床资料:收集自2002年1月以来的5例扩张型心肌病患者,年龄20～63岁,男性2例,女性3例,其中,心肌炎性心肌病1例,围生期心肌病1例,缺血性心肌病1例,酒精性心肌病1例.不明原因心肌病1例.伴糖尿病或糖耐量异常(IGT)2例,高血压2例,心房纤颤2例,室性心律失常1例,完全性左束支传导阻滞1例,安置人工心脏起搏器(双室起搏)1例.心功能Ⅱ～Ⅲ级(按NYHA分级标准).2)自体骨髓移植(ABMT):于髂后上棘采集自体骨髓,左侧2例,右侧3例;经肘静脉输注自体骨髓细胞.3)应用彩色多普勒超声心动图检测患者左房内径(LAD),左室舒张末径(LVEDD),左室收缩末径(LVESD),左室射血分数(LVEF)和左室舒张功能(E/A值).结果1)全部病例采髓及移植均成功,移植骨髓细胞(单核细胞)数目8.03×108～1.70×109;无移植物抗宿主病(GVHD),无感染等并发症.2)ABMT术后一个月,患者心功能恢复至Ⅰ～Ⅱ级.超声检测表明,LVEF从17%～37%增加至24%～56%,LAD,LVESD均有不同程度缩小;然而,LVEDD,E/A没有显著变化.3)随访3个月～6个月,除1例因恶性室性心律失常死亡外,余均存活.结论:ABMT治疗扩张型心肌病并心力衰竭是一种安全、有效的细胞治疗,它能通过加强心肌收缩力改善患者心功能,尤其是对年轻且病程短的患者.Objective To observe the preliminary treatment effect of autologous bone marrow transplantation（ABMT） on dilated caMiomyopathy （DCM） and heart failure. Methods 1）Clinical Data： we collected 5 patients since January 2002, aged from 20 to 63 years, male 2, female 3, with diagnosis of myocaMitis-induced DCM in 1, peripartal CM in 1, alcoholic CM in 1, ischemic CM in 1 and unclear reason DCM in 1. Companyed with DM or IGT in 2, hypertension in 2, atrial fibrillation in 2, ventricular arrhythmia in 1, CLBBB in 1 and set pacemaker（biventricular pacing） in 1. Grade Ⅱ-Ⅲ of cardiac function （NYHA）. 2）ABMT：autologous bone marrow were collected from the left posterior superior iliac spine in 2, the right posterior superior iliac spine in 3; All autologous bone marrow cells were transplanted by intravenous infusion. 3）LAD, LVEDD, LVESD, LVEF and E/A were determined by color doppler echocaMiography. Results 1） All patients＇ bone marrow were collected and transplanted successfully, the number of bone marrow cells （MNCs） from 8.03 ×10^8 to 1.70 × 10^9;No GVHD, no infection. 2）All patients＇ cardiac function recovered to grade Ⅰ-Ⅱ after one month of ABMT. Echo showed that LVEF were improved from 17% -37% to 24%-56%, LAD, LVESD decreased at different scales. However, there were no distinct change in LVEDD and E/A. 3）During follow-up period from one month to 6 months, all patients survived, but one died after 3 months because of severe ventricular tachycardia. Conclusion ABMT is a safe and effective cell therapy for DCM, it can improve patients＇ cardiac function by reinforcing its contraction, especially for younger patients with a shorter history.

关 键 词：扩张型心肌病 心力衰竭 自体骨髓 细胞移植 

分 类 号：R542.2[医药卫生—心血管疾病]