骨髓间充质干细胞移植联合透壁心肌打孔复合缓释支架在急性心肌梗死血运重建中的作用  

The Effect of Bone Marrow Mesenchymal Stem Cells Transplantation Combined with Transmyocardial Drilling Revascularization and Degradable Stent on Myocardium Revascularization after Acute Myocardial Infarction

作　　者：栾云[1] 刘晓程[1] 张光伟[1] 

机构地区：[1]中国医学科学院北京协和医学院泰达国际心血管病医院心脏外科,天津300457

出　　处：《中国胸心血管外科临床杂志》2009年第5期362-367,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：天津市科技发展计划资助项目(05YFGZSF02900)~~

摘　　要：目的探讨骨髓间充质干细胞(MSCs)移植联合透壁心肌打孔复合缓释支架对急性心肌梗死后血运重建的作用,为临床外科治疗心肌梗死提供依据。方法建立猪急性心肌梗死模型后,将24只猪采用随机数字表法分为4组,每组6只,对照组:单纯建立心肌梗死模型;MSCs组:心肌梗死后移植MSCs;透壁打孔再生血管术(TMDR)加支架组:心肌梗死后打孔加复合碱性生长因子(bFGF)肝素化缓释抗凝支架置入;MSCs联合TMDR加支架组:心肌梗死后打孔加复合bFGF的肝素化缓释抗凝支架置入联合MSCs移植。实验后3个月检测、分析4组的梗死区域心肌梗死面积和血管密度。结果术后3个月,病理组织学检测显示,MSCs组、TMDR加支架组和MSCs联合TMDR加支架组梗死面积均较对照组明显减少(27.9%±3.1%vs.48.9%±2.7%,P=0.000;20.3%±1.7%vs.48.9%±2.7%,P=0.000;12.5%±1.9%vs.48.9%±2.7%,P=0.000),血管密度均有不同程度的增加(8.4±1.2个/高倍视野vs.4.5±1.4个/高倍视野,P=0.001;11.5±2.6个/高倍视野vs.4.5±1.4个/高倍视野,P=0.001;15.6±1.4个/高倍视野vs.4.5±1.4个/高倍视野,P=0.000);其中MSCs联合TMDR加支架组梗死面积的减少和血管密度增加的程度较MSCs组和TMDR加支架组更明显(P=0.010,0.020)。结论MSCs移植联合TMDR加复合bFGF的肝素化缓释抗凝支架置入能减少心肌梗死面积,增加心肌梗死区域血管密度,从而提高MSCs移植在急性心肌梗死中的治疗作用,为临床外科治疗心肌梗死提供了新的治疗思路。Objective To investigate the effect of bone marrow mesenchymal stem cell （MSCs） transplantation combined with transmyocardial drilling revaseularization （ TMDR ） and degradable stent on myocardium revascularization after acute myocardial infarction（AMI）, and to provide the experimental evidence for surgical treatment of myocardial infarction. Methods After established models of AMI, the 24 pigs were divided into four groups with random number table, 6 pigs each group. Control group： only established models of AMI; MSCs group： AMI immediately followed by MSCs implantation; TMDR combined with stent group： AMI followed by TMDR and absorbable basic fibroblast growth factor （bFGF） stent implantation; MSCs combined with TMDR and stent group： AMI followed by TMDR and absorbable bFGF stent implantation, and then MSCs implantation. Three months after operation, the infarcted areas and vessel density in infarcted zone were detected by histopathology method. Results Three months after operation, the histopathological examination showed that infarcted areas in MSCs group, TMDR combined with stent group, and MSCs combined with TMDR and stent group were decreased as compared with control group （27.9%±3.1%vs.48.9%±2.7%,P=0.000;20.3%±1.7%vs.48.9%±2.7%,P=0.000;12.5%±1.9%vs.48.9%±2.7%,P=0.000） ; and vessel density was further increased （8.4 ±1. 2/HP vs. 4. 5± 1.4/HP, P= 0.001; 1l.5±2.6/HPvs. 4.5±1.4/HP, P=0.001; 15.6±l.4/HPvs. 4.5±1.4/HP, P=0.000）. ConclusionMSCs transplantation combined with TMDR and absorbable bFGF stents implantation could significantly reduce the infarction areas, increase the vessel density. This method may enhance the efficacy of MSCs transplantation in acute cardiac infarction model, which provide a new ideas for the surgical treatment of myocardial infarction.

关 键 词：心肌梗死 骨髓间充质干细胞 透壁打孔再生血管术 碱性生长因子 

分 类 号：R542.22[医药卫生—心血管疾病]