肝细胞移植治疗重型肝炎临床观察  

Clinical observation on the treatment of severe hepatitis with hepatocyte transplantation

作　　者：杨永平[1] 周霖[1] 马威[1] 王华明[1] 马雪梅[1] 冯永毅 王福生[1] 苏淑慧[1] 王春平[1] 安林静[1] 齐冬颖[1] 刘道践[1] 

机构地区：[1]解放军第302医院消化科,北京100039

出　　处：《解放军医学杂志》2007年第1期12-15,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家863计划基金资助课题(2003AA208106);军队医学杰出人才基金资助课题(04J20)

摘　　要：目的探讨人肝细胞体内移植治疗肝衰竭患者的有效性与安全性。方法从健康志愿者捐献的肝脏中获得人原代肝细胞并冷冻保存,复苏后经股动脉插管移植到脾脏,观察治疗后肝衰竭患者临床症状、生化指标、免疫指标及脾脏核磁共振信号的改变。结果人肝脏可获取2×1010肝细胞,复苏后肝细胞活率在75%以上。移植的肝细胞数为2×109个。移植后1个月,患者临床症状明显改善,血BIL、NH3、ALT、AST明显降低,IgG、IgA、IgM、C3和CD4/CD3在细胞移植后两周降至最低,4周后恢复移植前水平;PTA水平明显升高。出院80天和270天后,随访各项血生化指标均恢复正常。脾脏内可见肝细胞信号。结论肝细胞体内移植是一项安全有效的治疗方法,移植的肝细胞能够在脾脏内增殖、分化,替代或部分恢复肝脏合成、解毒和代谢功能;应用肝细胞增强剂做MIR扫描可成为一项新的肝细胞移植无创随访检测手段。Objective To investigate the effects and safety of human hepatocytes transplantation in vivo for the treatment of liver failure. Methods The primary human hepatocytes were collected from normal liver tissue donated by healthy volunteers and preserved by cryopreservation technique. After thawing, the hepatocytes were transplanted into the spleen of patients with severe hepatitis through catheterization of the femoral artery. Then the changes in clinical symptoms, serum biochemical indexes and MRI signals of the spleen were observed in the patients. Results A total of 2 × 10^10 hepatocytes were isolated from normal liver tissue of healthy volunteers and 75% of the hepatoeytes were alive after cryopreservation and thawing. The number of transplanted hepatocytes was 2 × 10^9. In the recipients, the clinical symptoms were markedly improved, serum levels of bilirubin, NH3, ALT and AST were significantly reduced, but that of PTA remarkably increased, after hepatoeyte transplantation. The follow-up examination was performed 80d and 270d after discharge from the hospital, and it was showed that all the serum biochemical indexes returned to normal and signals of the hepatocytes were found in the spleen. Conclusions Hepatocyte transplantation is a safe and effective therapy for severe hepatitis. The transplanted hepatocytes can proliferate and differentiate in the spleen to replace or partially compensate the liver function of synthesis, detoxication and metabolism. Contrast enhanced MRI can be a new method for follow-up study of transplanted hepatocytes.

关 键 词：重型肝炎 肝细胞移植 磁共振成像 

分 类 号：R617[医药卫生—外科学]