粒细胞集落刺激因子动员血管内皮祖细胞对心肌梗死后心力衰竭患者心肌能量消耗的影响  

Effect of endothelial progenitor cell treated by ranulocyte colony stimulating factor on cardiac function in patients with heart failure after myocardial infarction

作　　者：赵子粼[2] 郭志刚[1] 吴平生[1] 沈安娜[1] 许顶立[1] 

机构地区：[1]南方医科大学南方医院心内科,广州510515 [2]中国人民解放军第303医院心血管科,南宁530021

出　　处：《岭南心血管病杂志》2011年第5期356-360,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的研究应用粒细胞集落刺激因子（G—CSF）动员血管内皮祖细胞治疗心肌梗死后心力衰竭患者心功能及心肌能量消耗的改变。方法选取心肌梗死后心力衰竭患者38例，入院后均接受心肌梗死后心力衰竭的常规治疗（包括药物治疗和介入治疗），按电脑数字随机法分成治疗组和对照组。治疗组除常规治疗外还给予血管内皮祖细胞动员剂——粒细胞集落刺激因子（600ug／d）静脉注射，连续注射7d。检测两组治疗前、治疗后第7天和第4个月血浆脑钠钛（BNP）浓度及外周血内皮祖细胞数量，左心室射血分数、短轴缩短率、左心室收缩末期内径（left ventricular internal diameter at end．systole，LVIDs）、左心室舒张末期容积、收缩末期左心室后壁厚度（posterior wall thickniss，PWTs）、每搏输出量（stroke volume，SV）、射血时间（ejection time，ET）值。应用相关公式计算左心室收缩末圆周室壁应力（circumferential end—systolic wall stress，cESS）和心肌生物能量消耗（myocardiumenergy expenditure。MEE）。结果治疗组的血管内皮祖细胞数量较对照组增加明显，尤其第7天增加差异有统计学意义[（78．2±7．6）个眠（50．4±5．3）个，P〈0．01]。两组血浆脑钠肽浓度均较治疗前显著下降且恢复到正常值（P〈0．01）；两组心功能指标及MEE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周比对照组下降明显，差异有统计学意义[（251．3±29．5）×10^-2N／cm2 vs．（277．6±28．7）×10^-2 N／cm2，P〈0．01；（1．3±0．4）cal／systole vs．（1．5±0．4）cal／systole，P〈0．01]。治疗组左心室射血分数、短轴缩短率第4个月比对照组增加明显，差异有统计学意义（61．9％±6．9％vs．50．8％±6．5％，P〈0．01：32．3％±5．7％vs. 26．2％±4．3％，P〈0．01）。左心室Objectives To study the changes of cardiac function and myocardial energy expenditure in patients with heart failure after myocardial infarction treated with granuloeyte colony stimulating factor （G-CSF）. Methods Thirtyeight patients with heart failure after myocardial infarction were randomized divided into treatment group and control group. All patients received conventional treatment （medication and interventional therapy）, patients in treatment group were given additional G-CSF mobilization injection （600 ug/d）, continuous for 7 d. Plasma concentration of brain-type natriuretic peptide （ BNP ） and the number of endothelial progenitor cell （EPC） in peripheral blood were detected pretreatment and 7 d, 4 months post-treatment. Cardiac function [ejection fraction （EF）, shortening fraction （FS）, left ventricular internal diameter at end-systole （LVIDs）, posterior wall thickniss （PWTs）, end diastolic volume （EDV）, stroke volume （SV）, ejection time （ET）] was evaluated by ultrasonic imaging at pre-treatment and 2 weeks, 4 months post-treatment. Myocardium energy expenditure （MEE） and left ventrieular circumferential end systolic wall stress （cESS） were calculated by the formula. Results The number of EPC in treatment group increased more than that in control group, especially at 7 d post-treatment （78.2±7.6 vs. 50.4±5.3,P〈0.01）. The BNP concentration of the two groups decreased and returned to normal level after treatment （P〈0.01）. The level of cardiac function increased in all patients at 2 weeks, 4 months post-treatment, and the value were statistically different between two groups （P〈0.05）, especially at 2 weeks post-treatment the value of the the MEE, cESS decreased significantly compared with control group [ （251.3± 29.5） ×10^-2 N/cm2 vs. （277.6±28.7） ×10^-2 N/cm2, P〈0.01 ; （1.35±0.36） cal/systole vs. （1.46±0.41） cal/systole, P〈 0.01 ]. At 4 months post-treatment, the value of the EF, FS increased significantly

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：R542.22[医药卫生—心血管疾病]