冠状动脉内自体骨髓单个核细胞移植治疗急性心肌梗死患者的疗效  

Coronary delivery of autologous bone marrow cells in patients with acute myocardial infarction

作　　者：赵虹[1] 何冀芳[1] 魏嘉平[1] 李康[1] 李耘[1] 许立庆[1] 任文武[1] 温静[1] 周春燕[1] 韩涛[1] 田丁[1] 徐娟[1] 苏力[2] 张建[1] 

机构地区：[1]首都医科大学宣武医院心内科,北京100053 [2]首都医科大学宣武医院血液科,北京100053

出　　处：《临床心血管病杂志》2007年第11期811-815,共5页Journal of Clinical Cardiology

基　　金：2004年度首都医学发展基金(No:2003-2028)

摘　　要：目的:探讨急性心肌梗死患者自体骨髓单个核细胞经冠状动脉移植的安全性和对心功能的保护作用。方法:2003年3月以来,84例急性心肌梗死患者急诊静脉溶栓或急诊经皮冠状动脉成形术(PTCA)加支架治疗后2周内行择期冠状动脉造影或PTCA加支架治疗,其中50例抽取骨髓40ml,提取单个核细胞,经冠状动脉注入,另34例不做自体骨髓单个核细胞经冠状动脉移植,作为对照组。81例患者术前和术后6个月、2年均行多巴酚丁胺负荷试验(另3例未完成超声心动图随访观察)。结果:治疗组患者临床随访无明显不良反应,心功能明显改善,运动耐量增加。多巴酚丁胺负荷试验左室射血分数(LVEF)和室壁运动记分指数(WMSI)显著改善,峰值LVEF和WMSI与基础状态LVEF和WMSI的差值在治疗前后相比,与对照组相比均差异有统计学意义。结论:自体骨髓单个核细胞经冠状动脉移植治疗急性心肌梗死患者,经6个月～2年的临床观察无明显不良反应,具备安全性,多巴酚丁胺负荷试验显示出自体骨髓单个核细胞治疗对梗死后心功能有保护作用。Objective：This study is to assess clinical safety of intracoronary transplantation of autologous bone marrow cells in patients with acute myocardial infarction（AMI）, and to observe beneficial effect during the process of postinfarction remodeling. Method： There were 50 AMI patients randomly selected into bone marrow derived mononuclear in cells treatment group and 34 AMI patients in control group. All patients received emergency thromboysis or percutaneous transcoronary angioplasty（PTCA）, and had patency of TIMI Ⅲ. During the next 14 days, patients received PTCA＋ stenting for coronary stenosis. Dobutamine stress echocardiography were performed before and 6-month, 2-year after treatment. There were 40 ml aspirates of born marrow obtained in patients of cells treatment group. Mononuclear cells including endothelial progenitor cells were purified and counted, then transferred into infracted artery via 6F coronary angiography catheter. Result： Clinical follow up shows no side effect in 50 patients who received autologous bone marrow cells. Further more less nitroglycerin use and increased excise activity have been found in this group. Stress echocardiography shows significant improvement of left ventricular WMSI in treatment group patients. There were significant differences between peak WMSI and basement WMSI before and 6-month, 2-year after cell treatment. Conclusion.. Intracoronary autologous bone marrow cell transplantation is feasible and safey in patients with AMI. Stress echocardiography shows that autologous bone marrow cells transplantation plays a protective role in maintaining heart function after AMI.

关 键 词：干细胞移植 心肌梗死 冠状动脉 

分 类 号：R544.2[医药卫生—心血管疾病]