肝细胞移植治疗慢性乙型重型肝炎:2年随访(英文)  

Hepatitis B related liver failure treated with hepatocyte transplantation:A two-year follow-up

作　　者：周霖[1] 杨永平[1] 王春平[1] 马威[1] 王华明[1] 马雪梅[1] 冯永毅 苏淑惠 王福生[1] 安林静 齐冬颖 陆荫英[1] 陈艳[1] 贾红军[1] 

机构地区：[1]解放军第三〇二医院感染九科,北京市100039

出　　处：《中国组织工程研究与临床康复》2007年第29期5850-5853,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:近年来发展的肝细胞移植作为肝衰竭及遗传性代谢性肝脏疾病的一种治疗措施日益受到重视。目的:随访2年评估1例人肝细胞移植治疗慢性乙型重型肝炎患者的疗效。设计:病例报告,随访2年。单位:解放军第三○二医院感染九科及生物工程研究室。对象:纳入解放军第三○二医院感染住院的慢性重型肝炎患者1例。经实验室检查等确诊。用于移植的肝脏细胞由1名24岁供体提供,该供体生前签署过肝脏捐赠协议,且肝脏健康。方法:于2004-12在解放军第三○二医院放射科完成肝细胞体内移植。分离肝脏,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受体脾脏,观察治疗前后患者临床症状及血液生化指标改变及脾脏核磁共振信号的改变。患者术后每半年复诊检测1次肝功能、凝血功能、B超及胃镜检查、MRI,随访2年。主要观察指标:患者肝功能、凝血功能、影像学指标、免疫学指标、并发症和排斥反应发生情况。结果:①人肝脏可获取(1～2)×1010肝细胞,复苏后肝细胞存活率在60%以上,移植的肝细胞数为2×109个。②移植后2个月,患者临床症状明显改善,血胆红素、天门冬氨酸氨基转移酶明显降低,凝血酶原活动度明显升高。移植20个月后MRI提示脾脏内可见肝细胞信号。术后2年患者血总胆红素20μmol/L,直接胆红素7μmol/L,丙氨酸氨基转移酶416.75nkat/L,天门冬氨酸氨基转移酶533.44nkat/L,白蛋白37g/L,凝血酶原活动度90%,较术前明显改善(474.5,340.3μmol/L,400.08,1200.24nkat/L,38g/L,25%)。患者可从事正常一般家务活动及轻体力工作。未出现腹水及肝功能衰竭等并发症,未出现移植排斥反应。患者多次复查B超及胃镜均提示肝硬化及食道静脉曲张有进一步加重的趋势,曾2次因食道静脉曲张破裂出血而住院治疗。结论:肝细胞体内移植可改善肝功能,且未见移植排斥反应,但不能解BACKGROUND： Hepatocyte transplantation has attracted more and more attention as a therapeutic measure for liver failure and genetic metabolic liver diseases. OBJECTIVE： To evaluate the efficacy and safety of human hepatocyte transplantation in treating hepatitis B related liver failure in one case by a 2-year follow-up. DESIGN ： A case-report of 2-year follow-up SE-I-FENG： No.9 Department of Infectious Diseases, Bioengineering Research Room, the 302 Hospital of Chinese PLA. PARTICIPANT： One inpatient with hepatitis B related liver failure was selected from the 302 Hospital of Chinese PLA, and she was diagnosed according the laboratory tests. The transplanted hepatocytes were originated from the healthy liver of a 24-year-old man, who had signed the protocol for liver donation before death. METHODS： The hepatocyte transplantation was completed in the Department of Radiology, the 302 Hospital of Chinese PLA in December 2004. Liver was isolated to obtain human primary hepatocytes, and then cryopreserved. The hepatocytes were transplanted into recipient spleen via femoral vein after resuscitation. The clinical symptoms, changes of blood biochemical indexes, and changes of spleen MRI signals were observed before and after operation. The patient was reexamined every half a year after operation, including liver function, blood coagulation function, B-mode ultrasonography, gastroscopy and MRI, and she was followed up for 2 years. MAIN OUTCOME MEASURES： Liver function, blood coagulation function, imaging indexes, immunological indexes complication and rejection. RESULTS： ①Totally （1-2）×10^10 hepatocytes were harvested, and the viability of rewarmed hepatocytes was 60%, and finally 2×10^9 hepatocytes were transplanted. ②Two months later, the clinical symptoms of the recipient were obviously ameliorated, and serum bilirubin and aspartate aminotransferase （AST） were obviously decreased, while prothrombin activity was markedly increased. 20 months later, the MRI results showed that there was hepa

关 键 词：乙型肝炎 肝衰竭 肝细胞移植 随访 

分 类 号：R617[医药卫生—外科学]