急性心肌梗死后经冠状动脉自体骨髓单个核细胞治疗  

Intracoronary transplantation of autologous bone marrow cells in patients with acute myocardial infarction

作　　者：何冀芳[1] 赵虹[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] 张人玲[1] 刘丹[3] 马云川[4] 张建[5] 

机构地区：[1]首都医科大学宣武医院心内科,北京市100053 [2]首都医科大学宣武医院血液科,北京市100053 [3]首都医科大学宣武医院核医学科,北京市100053 [4]首都医科大学宣武医院PET中心,北京市100053 [5]首都医科大学宣武医院血管外科,北京市100053

出　　处：《中国介入心脏病学杂志》2008年第2期61-65,共5页Chinese Journal of Interventional Cardiology

基　　金：2004年度首都医学发展基金资助课题

摘　　要：目的探讨急性心肌梗死患者经冠状动脉自体骨髓单个核细胞治疗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PCI治疗后2周内行择期冠状动脉造影或PCI治疗。其中50例作为细胞治疗组,抽取骨髓40mL,提取单个核细胞,经冠状动脉注入;另34例作为对照组,经冠状动脉注入等量生理盐水。81例患者术前和术后6个月、2年行多巴酚丁胺负荷试验。29例治疗组患者和22例对照组患者术前和术后6个月行静态及动态心肌核素显像检查。结果细胞治疗组患者临床随访无明显副作用,心功能明显改善,运动耐力增加。多巴酚丁胺超声心动图负荷试验示左室射血分数(术前27.00%±0.89%,术后6个月36.80%±0.58%,术后2年40.94%±0.58%,术后6个月、2年与术前比,P均<0.01)和室壁运动记分指数(术前1.55±0.05,术后6个月1.32±0.03,术后2年1.24±0.02,术后6个月、2年与术前比,P均<0.01)显著改善,峰值射血分数(EF)与基础状态EF的差值(术前0.88%±0.54%,术后6个月15.06%±0.43%,术后6个月与术前比,P<0.01)及WMSI和基础状态WMSI的差值(术前0.07±0.02,术后6个月0.19±0.02,术后2年0.15±0.01,术后6个月、2年与术前比,P均<0.01)治疗前后之差异有统计学意义。动态与静态心肌核素显像提示梗死和缺血面积减小,存活心肌增加。结论经冠状动脉自体骨髓单个核细胞治疗的急性心肌梗死患者,经2年的临床观察无明显副作用,具备安全性,并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 To assess clinical safety and effect of intracoronary transplantation of autologous bone marrow cells in patients with acute myocardial infarction （AMI）. Methods Eighty four AMI patients who had received emergency thromblysis or primary PTCA were enrolled in this study. Elective PCI was undergone in these patients 10 - 14 days after infarction. During the procedure, 50 patients received introcoronary transplantation of autologous bone marrow derived mononuclear cells and the other 34 patients received normal saline as control. All patients achieved TIMI Ⅲ flow after PCI. Dobutamin stress echocardiography, SPECT and F-18-Fluorodeoxyglucose-PET were performed 1 day before and 6 months after the transplantation. All patients finished a 2-year follow up and stress echo examination. Twenty nine patients from the transplantation group and 22 patients from the control group accepted 6-month SPECT reassessment. Results No major adverse events were recorded in all patients who received autologous bone marrow cells transplantation during follow up. Less nitroglycerin usage and increased excercise were observed in the transplantation group. Stress echocardiography showed improvement in LVEF （27.00% ±0. 89% preoperation, 36.80%±0.58% after 6 months and 40.94% ±0.58% after 2 years, P 〈0.01） and left ventricular wall motion score index （WMSI） （ 1.55 ±0. 05 pre-operation, 1.32±0.03 after 6 months and 1.24±0. 02 after 2 years, P 均 〈0. 01 ） in the transplantation group. Statistical significances were found in the difference between peak and basal EF （0. 88% ± 0. 54% pre-operation vs 15. 06% ± 0. 43% after 6 months, P 〈 0. 01 ） as well as in the difference between peak and basal WMSI （0. 07 ± 0.02 pre-operation, 0. 19 ± 0. 02 after 6 months and 0. 15 ± 0. 01, P 〈 0. 01 ） in the transplantation group. Compared with the pre-operation result, the infarction size and ischemic area demonstrated in SPECT and PET examination were reduced 6 months after the transplantation. Conclusi

关 键 词：骨髓细胞 心肌梗死 超声心动描记术 压力 体层摄影术 发射型计算机 单光子 正电子发射断层显像术 

分 类 号：R541.4[医药卫生—心血管疾病] R542.22[医药卫生—内科学]