介入移植自体骨髓间充质干细胞治疗失代偿期肝硬化的临床研究  

Study on the interventional transplantation of autologous bone marrow mesenchymal stem cells in the treatment of patients with decompensate cirrhosis

作　　者：张宏文[1] 邓小军[1] 邓梨平[1] 谢卫华[1] 刘旭云[1] 段诗姣[1] 

机构地区：[1]湖南省衡阳市,南华大学附属南华医院介入科,421002

出　　处：《中国综合临床》2013年第1期69-72,共4页Clinical Medicine of China

摘　　要：目的探讨自体骨髓间充质干细胞（MSCs）移植对肝硬化失代偿期患者的治疗作用。方法25例肝硬化失代偿期及肝衰竭患者无菌抽取骨髓150—200ml，参照Wollert报道方法分离纯化MSCs，然后经肝动脉导管注入肝脏。术后定期检测肝功能和凝血功能，并观察同期的症状体征和不良反应情况。结果术后2周内所有血清学指标均无显著性改变；与术前[（26．65±5．30）g／L]比较术后4周血清白蛋白为（30．91±4．00）g／L（t=3．07，P〈0．05）。至12周升至（32．00±6．18）g／L（t=3．02，P〈0．01）；术后12周与术前比较总胆红素[（39．94±21．15）mmol／L与（125．01±150．05）mmol／L，t=2．63，P〈0．05]；总胆汁酸[（41．63±33．91）μmol／L与（78．00±59．80）μmol／L，t=2．53，P〈0．05]，差异均有统计学意义。肝酶指标术后4周与术前比较均有明显变化（P均〈0．05）。术后12周与术前比较凝血酶时间及纤维蛋白原分别为（14．71±1．59）s与（21．40±6．07）s（t=5．01，P〈0．01）和（2．64±0．61）g/L（1．66±0．94）g／L（t=4．17，P〈0．01）。术后1周食欲、体力改善分别为90．67％和88．5％；第2周16例患者（63．5％）肝病面容好转，有1例蜘蛛痣明显减少；术后12周的总生存率为77．44％，其中移植2周后死亡及失访者共3例，死因为慢性肝衰竭合并自发性细菌性腹膜炎或DIC或肝肾综合征。所有患者均未发现细胞移植并发症。结论自体MSCs移植治疗失代偿期肝硬化近期安全有效，患者肝功能、凝血功能改善明显，生存质量提高，但应严格掌握适应证。Objective To evaluate the effect of autologous bone marrow-derived stem cell （MSCs） transplantation in the treatment of decompensated hepatic cirrhosis. Methods Bone marrow was harvested （ 150 - 200 ml） from 25 patients with decompensated cirrhosis and hepatic failure. The MSCs were isolated according to the method reported by Wollert and infused into liver via hepatic artery catheter. At different time points after the transplantation, the patients＇ liver function and prothrombin time （PT） were evaluated, and the survival rate and symptoms of the patients were recorded. Results All the serum biochemical indexes remained stable 2 weeks after the transplantation, and at 4 weeks after transplantation, levels of albumin was increased significantly in comparison with the preoperative level（ （30. 91 ±4. 00） g/L vs （26. 65±5. 30） g/L,t =3. 07, P 〈0. 05）. At 12 weeks,the levels of albumin further increased（ （32. 00 ±6. 18） g/L vs （26. 65 ±5.30） g/L, t = 3.02 P 〈 0. 01 ）. While at 12 weeks after operation, there was significant difference on the total bilirubin （ （39. 94 ± 21.15 ） mmol/L vs （ 125.01 ± 150. 05 ） mmol/L; t = 2. 63, P 〈 0. 05 ）, tolal bile acid （ （41.63 ± 33.91 ） μmol/L vs （78.00 ± 59. 80 ）μmol/L;t = 2. 53 ,P 〈 0.05 ） when compared with the preoperative level. 4 weeks after operation, the liver enzyme indicators changed significantly when compared with the preoperative level （P 〈0. 05）. At 12 weeks after operation,there was significant difference on the PT（ （ 14. 71 ± 1.59） s vs （21.40 ± 6.07） s,t = 5.01,P 〈 0. 01 ） and the level of fibrinogen （ （2. 64 ± 0. 61 ） g/L vs （ 1.66 ± 0. 94） g/L, t = 4. 17 ,P 〈 0. 01 ）. I week after the transplantation ,90. 67% patients exhibited improved appetite and 88.5% patients showed better physical strength;at 2 weeks, hepatic face improved in 16 cases （63.5%）, and spider telangiectasia was significantly reduced in 1 case;at 12 weeks,the survival rate of

关 键 词：骨髓干细胞 移植 肝硬化 

分 类 号：R575.2[医药卫生—消化系统]