自体外周血干细胞经冠状动脉移植治疗急性心肌梗死:近期疗效随访  

Autologous peripheral blood stem cell transplantation via coronary artery for acute myocardial infarction:A follow-up of short-term curative effect

作　　者：张明 李占全[2] 金元哲 袁龙[2] 张薇薇[2] 刘莹[2] 崔丽杰[2] 刘显智[3] 余宪[4] 胡铁石[5] 于乐 

机构地区：[1]辽宁省中医药大学附属医院中西医结合心血管内科,辽宁省沈阳市110032 [2]辽宁省人民医院辽宁省心血管病医院心内科,辽宁省沈阳市110016 [3]沈阳市中心血站,辽宁省沈阳市110044 [4]辽宁省肿瘤医院检验科,辽宁省沈阳市110042 [5]辽宁省人民医院辽宁省心血管病医院检验科,辽宁省沈阳市110016

出　　处：《中国组织工程研究与临床康复》2007年第20期3944-3947,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:观察经皮经腔冠状动脉内移植外周血干细胞治疗急性心肌梗死的可行性与近期临床疗效。方法:①实验对象:选取2003-11/2005-01辽宁省人民医院收治的急性心肌梗死患者70例,男56例,女14例,年龄(60±10)岁,体质量(73±11)kg,急性心肌梗死病程(5±2)d,均对本实验知情同意,实验方案经辽宁省人民医院伦理委员会批准。70例患者随机数字表法分为细胞移植组、常规治疗组,35例/组。两组基线资料基本相似。②实验方法:常规治疗组单纯给予药物治疗+冠状动脉造影术或支架植入术。细胞移植组在常规治疗的基础上应用粒细胞集落刺激因子皮下注射动员自体骨髓干细胞,连续5d,第6天经血细胞分离机分离采集外周血干细胞悬液57mL,经over the wire球囊导管中心腔注入梗死相关动脉,注入CD34细胞数量为(7.25±7.33)×107个。③实验评估:在外周血干细胞动员、采集及经冠状动脉回输过程中观察患者不良反应。于术前及术后6个月检查两组患者左室形态、心功能、室壁节段性运动积分的改变。结果:术后6个月,细胞移植组全部完成随访,常规治疗组23例完成随访。①手术前后超声心动图参数值的变化:与术前比较,术后6个月细胞移植组左室收缩末容积、室壁节段性运动积分指数均明显下降(P<0.05),左室射血分数显著升高(P<0.05)。术后6个月与常规治疗组比较,细胞移植组左室射血分数明显升高,室壁节段性运动积分指数显著降低,差异有显著性意义(P<0.05)。②安全性评估:外周血干细胞动员时不良反应占37.1%,分离和采集过程不良反应占15.3%,经冠状动脉内回输过程不良反应占20.0%。结论:经皮经腔冠状动脉移植自体外周血干细胞治疗急性心肌梗死,可在近期有效地减少心肌梗死缺血面积,减轻左室重构,改善心功能。AIM： To investigate the safety and short-term efficacy of percutaneous transluminal intracoronary transplantation of autologous peripheral blood stem cells in patients with acute myocardial infarction （AMI）. METHODS： （1）Totally 70 AMI patients （56 males and 14 females） aged （60±10） years with the body mass of （73±11） kg were enrolled from Liaoning Provincial People＇s Hospital from November 2003 to January 2005, The course of AMI was （5±2.） days and the patients knew and agreed to participate in the experiment, The experiment was approved by Ethics Committee of Liaoning Provincial People＇s Hospital, The 70 patients were randomly divided into cell transplantation group and conventional treatment group with 35 in each group. The basic data of the patients were similar in the two groups. （2） The patients in the conventional treatrhent group only received drug plus coronary angiography or trestle implantation, Those in the conventional treatment group except the conventional treatment received autologous bone marrow stem cells mobilization by granulocyte colony-stimulating factor （G-CSF） subcutaneously for successively 5 days, 57 mL per（pheral blood stem cell suspension was collected by blood cell separator and injected into arteries in infarced region over the wire Foley＇s tube at day 6 and the amount of CD34 was （7.25±7.33）×10^7. （3）Adverse reactions during stem cell mobilization, collection and percutaneous intracoronary back transfusion were monitored. Left ventricular morphology, heart function and regional wall motion integration of patients in the two groups were determined before operation and 6 months after operation. RESULTS： Six months after operation, follow-up was performed in 35 cases of the cell transplantation group and 23 cases in the conventional treatment group. （1）Chocardiogram parameter value： Compared with that before operation, left ventricular end systolic volume （LVESV） and regional wall motion integration were obviously decr

关 键 词：急性心肌梗死 外周血干细胞 心功能 移植 粒细胞集落刺激因子 

分 类 号：R394.2[医药卫生—医学遗传学]