自体骨髓单个核细胞移植治疗扩张型心肌病疗效观察  

Effects of intracoronary autologous bone marrow mononuclear cells transplantation in patients with dilated cardiomyopathy

作　　者：陈岩[1] 高恩民[1] 高传玉[1] 徐予[1] 黄克钧[1] 牛振民[1] 朱中玉[1] 杨宏辉[1] 李牧蔚[1] 

机构地区：[1]河南省人民医院心内科,郑州450003

出　　处：《中华心血管病杂志》2008年第12期1087-1091,共5页Chinese Journal of Cardiology

摘　　要：目的观察扩张型心肌病患者经冠状动脉自体骨髓单个核细胞移植治疗的安全性及近中期疗效。方法258例扩张型心肌病患者，传统治疗的基础上，根据是否行经冠状动脉自体骨髓单个核细胞移植分为移植组（n=71）和对照组（n=187）。随访两组患者术前、术后1、3、6个月和1、2年超声心动图、动态心电图、6min步行距离及心脏核素（SPECT）检查，记录年住院天数。结果移植组6min步行距离术后1个月明显优于对照组[（345±76）m比（286±104）m，P〈0．05]。术后各随访时间点比较，移植组均优于对照组（P〈0．05）。术后1个月，移植组左心室射血分数（LVEF）明显高于对照组[（41．5±9．4）％比（37．3±6．6）％，P〈0．05]。术后2年时移植组LVEF略高于对照组，差异无统计学意义[（43．6±6．3）％比（43．2±6．0）％，P〉0．05]。术后3个月移植组缺血心肌节段数较术前减少，且较对照组少[分别为（2．0±1．0）个比（3．1±1．4）个和（2．0±1．0）个比（3．1±1．2）个，P均〈0．05]，而坏死心肌节段数移植前后无明显改变。两组患者生存率比较，差异无统计学意义（95．4％比94．9％，P〉0．05）。但移植组患者年住院天数明显少于对照组[（23．6±13．4）d比（33．0±14．0）d，P〈0．05]。结论经冠状动脉自体骨髓单个核细胞移植具有良好的安全性，能够提高扩张型心肌病患者的LVEF、增加6min步行距离，减少年住院天数，且近期疗效显著，中期疗效与传统治疗相似。Objective To evaluate the safety and efficacy of intracoronary autologous bone marrow mononuclear cells （BM-MNCs） transplantation in patients with dilated cardiomyopathy （DCM）. Methods On top of standard therapy, DCM patients received BM-MNCs transplantation （n = 71 ） or saline injection （n = 187）. The baseline clinical characteristics of two groups were comparable. Data on echocardiography, Holter, six-minute-walk test, cardiac SPECT and annual hospital days were obtained in all patients at baseline, 1, 3, 6, 12 and 24 months after transplantation. Results Six-minute-walk distance was significantly longer at one month [ （ 345 ± 76 ） m vs. （ 286± 104 ） m, P 〈 0. 05 ] and thereafter （ all P 〈 0. 05 ） in BM-MNCs group compared with saline group. Left ventricular ejection fraction（LVEF） at one month in BM-MNCs group was significantly higher compared with saline group [ （41.5± 9. 4 ）% vs, （37. 3 ± 6. 6） %, P 〈 0. 05 ] and with pre-transplantation value [ （41.5 ±9.4 ） % vs. （ 32. 4 ± 8. 5 ） %, P 〈 0. 05 ] while LVEF was similar at 24 months after transplantation between the two groups [ （43.6 ± 6. 3 ） % vs. （43.2 ± 6.0 ） % , P 〉 0.05 ] . Three months after transplantation, the number of isehemie segments of BM-MNCs group was significantly reduced compared with that of saline group （ 2. 0 ± 1.0 vs. 3. 1 ± 1.4, P 〈 0. 05 ） and with baseline （ 2. 0 ±1.0 vs. 3.1± 1.2, P 〈 0. 05 ） while the number of necrotic segments were similar in both groups during the follow-up. There were no significant difference in survival between two groups during 2 years follow-up （95.4% vs. 94. 9%, P 〉 0. 05 ）but the annual hospitalization days of BM-MNCs group was significantly lower than that of saline group [ （23.6 ±13.4） d vs. （33.0 ±14. 0） d, P 〉 0. 05 ]. Conclusions Intracoronary transplantation of autologous BM-MNCs was safe and could increase LVEF and the six-minute-walk distance and reduce hospitalization days for patients with d

关 键 词：心肌病 扩张型 干细胞移植 治疗结果 

分 类 号：R686[医药卫生—骨科学]