冠状动脉自体骨髓CD34^+干细胞移植治疗心绞痛:随机对照临床分析  

Intracoronary transplantation with autologous bone marrow CD34^+ stem cells for angina:A randomized controlled clinical analysis

作　　者：王世宏[1] 崔俊玉[1] 路敏[1] 王显[1] 李晓明[1] 谭琛[1] 张健[1] 赵怀兵[1] 

机构地区：[1]解放军北京军区总医院心肺血管病中心,北京市100700

出　　处：《中国组织工程研究与临床康复》2009年第14期2623-2626,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:大量基础和临床研究结果提示,骨髓CD34+干细胞具有明显的促进血管新生作用。经作者查新检索,目前国际上仅有1篇小样本心腔内注射骨髓CD34+干细胞治疗心绞痛的报道。目的:评价冠状动脉内CD34+干细胞移植治疗心绞痛的安全性和有效性。设计:回顾性病例分析。对象:选取2007-07/2008-07解放军北京军区总医院心内科住院的32例心绞痛患者,按患者意愿分为治疗组和对照组,移植前1个月内均无急性心肌梗死病史,心绞痛加拿大心血管学会分级为Ⅱ～Ⅳ级,两组患者基线资料比较无统计学差异(P>0.05)。方法:治疗组患者在接受最佳药物治疗的基础上,于常规PCI术后,行冠状动脉内自体骨髓CD34+干细胞移植,于冠状动脉病变近端注入CD34+干细胞悬液15mL,细胞数为(1.0～6.1)×106。对照组患者仅接受最佳药物治疗和导管置入。主要观察指标:移植后两组患者的疗效指标比较及心肌血液灌注情况。结果:骨髓干细胞移植后,治疗组心绞痛发作频率、硝酸甘油的用量、运动时间及加拿大心血管学会心绞痛分级等各项疗效指标均明显优于对照组(P<0.001～0.05),且移植后6个月时的治疗效果优于移植后3个月。移植后6个月,治疗组患者心肌灌注缺损面积明显小于对照组(P<0.01)。随访6个月内,未观察到因冠状脉动脉内注射而导致的心肌梗死、心肌酶升高、心肌穿孔、心包积液、室性心动过速或室颤等严重不良事件发生。结论:冠状动脉内注射自体骨髓CD34+干细胞后,可显著改善心绞痛患者心肌血液灌注,安全有效。BACKGROUND： Bone marrow CD34＋ stem cells have significant promoting effects on angiogenesis. Presently, authors only searched one study concerning bone marrow CD34＋ stem cells for treating angina pectoris by direct injection into ventricle in small samples. OBJECTIVE： To evaluate the safety and efficacy of transplantation of autologous bone marrow CD34＋ stem cells for angina. DESIGN, TIME AND SETTING： The retrospective case analysis. PARTICIPANTS： A total of 32 patients suffered from angina were selected from the Department of Cardiology, General Hospital of Beijing Military Area Command of Chinese PLA from July 2007 to July 2008. They were randomly assigned into treatment and control groups. None of them had the history of acute myocardial infarction within 1 month before transplantation. Angina grade was from Ⅱ-Ⅳ grades by Canada Cardiovascular Association. No significant differences in baseline data were detected between two groups （P 〉 0.05）. METHODS： Following optimal drug treatment and conventional PCI, patients in the treatment group received autologous bone marrow CD34＋ stem cell transplantation through coronary artery. 15 mL of CD34＋ stem cell suspension, about （1.0-6.1）× 10^6 cells was infused into the proximal end of coronary artery disease lesion. Patients in the control group only received optimal drug treatment and catheter implantation. MAIN OUTCOME MEASURES： Curative effect indices and hemoperfusion in patients of both groups following transplantation. RESULTS： Following bone marrow stem cell transplantation, angina pectoris attaches, nitroglycerin dose, movement time and Canadian Cardiovascular Society class indices were better in the treatment group compared with the control group （P 〈 0.001-0.05）. At 6 months following transplantation, the therapeutic efficacy was better compared with that at 3 months. At 6 months, myocardial perfusion defect area was significantly smaller in the treatment group compared with the control group （P 〈 0.01）. Withi

关 键 词：CD34+细胞 骨髓干细胞 冠状动脉 心绞痛 

分 类 号：R394.2[医药卫生—医学遗传学]