肝细胞生长因子联合自体骨髓间充质干细胞移植治疗矽肺一例  

Hepatocyte growth factor combined with autologous bone marrow mesenchymal stem cell transplantation for treatment of silicosis

作　　者：刘薇薇[1] 陈嘉榆[2] 余卫[2] 叶更新[3] 张程[1] 杨志前[1] 刘移民[4] 钟雪云[5] 郭子宽[6] 

机构地区：[1]广州市第十二人民医院职业病科,510620 [2]广州市第十二人民医院血液科,510620 [3]广州市第十二人民医院放射科,510620 [4]广州市第十二人民医院院科技委员会,510620 [5]暨南大学医学院病理学系 [6]军事医学科学院放射与辐射医学研究所实验血液学研究室

出　　处：《中华劳动卫生职业病杂志》2011年第1期39-43,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：基金项目：广州市医药卫生科技重点项目（2008-ZDi-04）（中国军事医学科学院吴祖泽院士为本研究免费提供HGF真核表达质粒,志谢）

摘　　要：目的探讨采用肝细胞生长因子（HGF）联合骨髓间充质干细胞（BMSC）白体移植治疗矽肺患者的潜在作用。方法选取我院确诊的1名Ⅱ＋矽肺患者，经医学伦理委员会批准，患者自愿同意抽取自体骨髓100ml，体外分离，纯化培养BMSC。取第3代细胞，加入脂质体（lip02000）及p-HGF共培养2d。收获P—HGF—BMSC细胞5×10^7个细胞后，用生理盐水50ml静脉滴注回输给患者，每周1次，连续3次。移植治疗后第1个月复查，以后每3个月复查1次，直至观察12个月。观察指标：（1）高仟伏X线胸片、胸部CT；（2）肺功能；（3）血清铜蓝蛋白。结果治疗后追踪12个月后，患者咳嗽、胸闷症状基本消失，病情稳定。肺功能检查：用力肺活量（FVC）从治疗前64．6％提高到治疗后的81．0％，第1秒用力呼气容积（FEV1.0）从治疗前68．7％提高到治疗后的90．1％，1秒率（FEV10／FVC％）从治疗前111．6％降到治疗后的107．1％，最大呼气中期流量（FEF29%-75%）从治疗前100．3％降到治疗后的94．6％，用力呼出75％肺活量位气体的瞬间流量（MEF75%）从治疗前99．2％升高到治疗后的113．5％，用力呼出50％肺活量位气体的瞬间流量（MEF。）从治疗前125．3％升高到治疗后的130．2％，用力呼出25％肺活量位气体的瞬间流量（MEF25%）从治疗前86．9％降到治疗后的71．7％；血清铜蓝蛋白含量从治疗前690mg／L降到治疗后180．6mg／L；胸部CT在第1次复查显示“双肺野细小结节小阴影密集及分布均较治疗前有所减少”。高仟伏X线胸片在第2次复查显示“双肺从肺尖到肺底均见弥漫分布小结节阴影，边缘尚清较前有所吸收、好转”。患者无明显不适的表现。结论HGF联合BMSC移植方法可能对改善矽肺患者肺结节和纤维化有一定潜在作用。Objective To evaluate the potential role of hepatocyte growth factor （HGF） combined with bone marrow mesenchymal stem cells （BMSC） autograft for the treatment of silicosis： Methods Bone marrow （ 100 ml） was aspirated from a severe silicosis patient. BMSCs isolated, purified and cultured in vitro. When BMSC came to 70% confluence at passage 3, the culture medium was added liposomes （lipo2000） and plasmid-HGF （p-HGF） and cultured for 2 d. HGF-MSCSs （5×10^7 cells） were resuspended in 50 ml 0.9% sodium chloride （NS） and infused Intravenous drip at 3 consecutive times （once a week）. Clinical follow-up were performed before and after treatment： （ 1 ） pulmonary high-kV X-ray, chest CT examination; （2） pulmonary function test; （3） determination of serum ceruloplasmin. Results The symptoms such as coughing, chest tightness disappeared at 12 months after treatment. Pulmonary function tests showed significant changes after treatment： forced vital capacity （FVC） increased from 64.6% to 81.0%, forced expiratory volume in one sec- ond（FEVL0） increased from 68.7% to 90.1%, 1 second rate （FEVJFVC%） reduced from 111.6% to 107.1%, the maximum mid-expiratory flow（FEF25%-75%） decreased from 100.2% to 94.6%, forced expiratory vital capacity 75% of the moment bit of gas flow （MEF75%） increased from 99.2% to 113.5%, forced expiratory vital capacity 50% of the moment bit of gas flow （MEF50%） increased from 125.3% to 130.2%, forced expiratory vital capacity 25% of the moment bit of gas flow （MEF25%） reduced from 86.9% to 71.7%; serum ceruloplasmin levels decreased from 690 mg/L to 180.6 mg/L; lung high-kV X-ray at 1st review showed that diffuse lung noduleshad been absorbed and getting smaller than before treatment; chest CT showed that the distribution and number of small nodules at double lung fields decreased than before treatment. Conclusion HGF combined with BMSC transplantation may have some potential role for the treatment of silicosis patients.

关 键 词：矽肺 肝细胞生长因子 干细胞 干细胞移植 

分 类 号：R1[医药卫生—公共卫生与预防医学]