内皮祖细胞对心肌梗死后心力衰竭患者心功能及心肌能量消耗的影响  

Effects of endothelial progenitor cells on cardiac function and myocardial energy expenditure in patients with heart failure after myocardial infarction

作　　者：赵子粼[1] 许顶立[1] 郭志刚[1] 沈安娜[1] 

机构地区：[1]南方医科大学南方医院心内科,广州510515

出　　处：《临床心血管病杂志》2011年第7期526-530,共5页Journal of Clinical Cardiology

基　　金：广东省科技计划项目(No:2009B030801204);广东省自然科学基金项目(No:8151051501000048)

摘　　要：目的:研究应用粒细胞集落刺激因子(G-CSF)动员内皮祖细胞(EPC)治疗心肌梗死(MI)后心力衰竭(心衰)患者心功能及心肌能量消耗的改变。方法:选取38例MI后心衰患者,入院后均接受MI后心衰的常规治疗(包括药物治疗和介入治疗),随机分成治疗组和对照组,治疗组除常规治疗外还给予EPC动员剂G-CSF(600μg/d)皮下注射,连续7 d。检测2组治疗前、治疗后第7天和第4个月血浆脑利钠钛(BNP)值及外周血EPC数量,治疗前、治疗后第2周和第4个月行心脏超声检测左室心功能指标:左室射血分数(LVEF)、短轴缩短率(FS)、收缩末期内径、左室壁厚度、左室舒张末期容积、每搏量、射血时间,应用相关公式计算心肌能量消耗(MEE)、左室收缩末圆周室壁应力(cESS)。结果:治疗组的EPC数量较对照组增加明显,尤其第7天增加有显著差异(P<0.01);2组患者血浆BNP值较治疗前均显著下降且恢复正常值(P<0.01);2组心功能指标及心肌能量消耗治疗后均有所好转(P<0.05),治疗组较对照组改善明显(P<0.05),尤以治疗组cESS、MEE第2周下降明显,差异有统计学意义(P<0.01);及治疗组LVEF、FS第4个月增加明显,差异有显著性(P<0.01)。结论:应用G-CSF动员EPC治疗MI后心衰患者,可有效改善心功能,减轻心室重构,降低心肌能量消耗。Objective：To study the changes of cardiac function and myocardial energy expenditure following treatment with the granulocyte colony stimulating factor（G-CSF） in patients with heart failure after myocardial infarction.Method：Thirty-eight patients with heart failure after myocardial infarction were randomized into the G-CSF treatment group and control group.All the patients received conventional treatment（medication and interventional therapy）,and the patients in treatment group were given additional G-CSF（600 μg/d） for 7 consecutive days.The plasma level of braintype natriuretic peptide（BNP） and the number of endothelial progenitor cells（EPC） in the peripheral blood were detected before and at 7 days and 4 months after treatment.The cardiac function（LVEF,FS,LVIDs,PWTs,EDV,SV,ET） were evaluated by ultrasonic imaging before and at 2 weeks and 4 months after treatment.The MEE and circumferential endsystolic wall stress（cESS） were calculated by correlation formula.Result：The number of EPC was significantly higher in the treatment group than in the control group after the treatment especially at 7 days（P0.01）.In both groups,BNP levels were lowered significantly after the treatment to normal level（P0.01）.The cardiac functions and myocardial energy expenditure improved in all patients at 2 weeks and 4 months after the treatment,and the improvements were more obvious in the treatment group（P0.05）,especially in terms of MEE and cESS was significantly lowered in the treatment group than in the control group after the treatment at 2 weeks（P0.01）,the LVEF and FS were significantly increased in the treatment group than in the control group after the treatment at 4 months（P0.01）.Conclusion：EPC mobilization by G-CSF can effectively improve the cardiac functions,lessen ventricular remodeling and reduce myocardial energy expenditure in patients with heart failure after myocardial infarction.

关 键 词：心肌梗死 内皮祖细胞 粒细胞集落刺激因子 心力衰竭 心功能 心肌能量消耗 

分 类 号：R542.2[医药卫生—心血管疾病]