TIPS联合自体骨髓干细胞移植治疗失代偿期肝硬化  

TIPS combined with autologous bone marrow stem cell transplantation for treatment of decompensated liver cirrhosis

作　　者：黄茂涛[1] 曹亚玲[1] 冯早明[1] 季代金[1] 张文华[2] 史小英[1] 王平[1] 汤敏[1] 谭瓛[1] 谢永祥[1] 赵睿婷[1] 

机构地区：[1]中国人民解放军第452医院消化内分泌科,四川省成都市610021 [2]中国人民解放军第452医院放射科,四川省成都市610021

出　　处：《世界华人消化杂志》2013年第30期3275-3280,共6页World Chinese Journal of Digestology

基　　金：四川省卫生厅科研课题基金资助项目;No.100193~~

摘　　要：目的:探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)联合自体骨髓干细胞移植治疗失代偿期肝硬化的有效性和安全性.方法:失代偿期乙型肝炎后肝硬化患者5例,2例患者Child-Pugh评分B级,3例患者ChildPugh评分C级.同时行TIPS和自体骨髓干细胞移植,随访1年,比较患者术前术后的症状、体征、生化指标、内镜下改变.结果:术后所有患者腹水减少,术后分别于1、4、12、25、52 w k随访.所有患者临床表现、生化指标均有改善,内镜下食管和胃底静脉曲张程度减轻,未发生上消化系出血.术后第52周(1年)所有患者未再出现顽固性腹水,腹水维持在少量.复查肝功,白蛋白(albumin,ALB)从27.3 g/L升至31.5 g/L(P=0.014)、总胆红素(total bilirubin,TB)从49.5 mol/L降至41.8 mol/L(P=0.045),转氨酶(alanine aminotransferase,ALT)从54.3I U/L降至45.7 I U/L(P=0.063)以及凝血酶原时间(prothrombintime,PT)从18.7 s降至16.5 s(P=0.063)略减低,Child-Pugh评分均为B级.结论:TIPS联合自体骨髓干细胞移植治疗失代偿期肝硬化疗效显著、不良反应小、有较高的安全性,值得进一步的探索.AIM： To assess the efficacy and safety of transjugular intrahepatic portosystemic shunt （TIPS） combined with autologous bone marrow stem cell transplantation in the treatment of decompensated liver cirrhosis. METHODS： Five patients with decompensated liver cirrhosis caused by hepatitis B, of whom two had Child-Pugh class B and three had Child-Pugh class C disease, underwent simultaneous combination therapy with TIPS and autologous bone marrow stem cell transplantation. All patients were followed for one year. Clinical symptoms, physical signs, biochemical indices, and endoscopic findings were compared between before and after the combination therapy. RESULTS： Ascites was alleviated in all patients after treatment. Each patient was followed at 1, 4, 12, 25, and 52 wk after treatment. All patients achieved substantial improvement in clinical symptoms and biochemical indices. The varices in the esophagus and gastric fundus were alleviated as shown by endoscopic observation, and no upper gastrointestinal bleeding occurred. During the 52-wk follow-up period, no patients experienced refractory ascites, and the patients showed only small amounts of ascites. Liver function was remarkably improved; albumin （ALB） increased significantly （from 27.3 g/L to 31.5 g/L, P = 0.014）, total bilirubin （TB） decreased significantly （from 49.5 μmol/L to 41.8 μmol/L, P = 0.045）, and all patients showed decreased alanine aminotransferase （ALT） （from 54.3 IU/L to 45.7 IU/L, P = 0.063） and prothrombin time （PT） （from 18.7 s to 16.5 s, P = 0.063）. Liver cirrhosis was classified as Child-Pugh class B in all patients. CONCLUSION： TIPS in combination with bone marrow stem cell transplantation is associated with remarkable therapeutic effects and minimal adverse reactions in the treatment of decompensated liver cirrhosis.

关 键 词：肝硬化 经颈静脉肝内 门体分流 干细胞移植 

分 类 号：R575.2[医药卫生—消化系统]