两种途径移植自体骨髓干细胞治疗肝硬化患者的疗效比较  

Therapeutic effect of autologous bone marrow stem cell transplantation through portal vein or hepatic artery in treatment of decompensated liver cirrhosis: a comparative study

作　　者：王方[1] 寇俊峰[1] 云升皓[1] 蔡国芳[1] 王可敬[1] 杨兴坤[1] 

机构地区：[1]兰州军区总医院安宁分院感染科,兰州730070

出　　处：《临床肝胆病杂志》2013年第11期844-847,共4页Journal of Clinical Hepatology

摘　　要：目的比较经肝动脉和门静脉移植自体骨髓干细胞治疗失代偿期肝硬化患者的疗效和安全性。方法回顾性分析2006年12月至2012年5月50例住院患者资料,门静脉治疗组失代偿期肝硬化患者25例和肝动脉治疗组25例,两组基线特征差异无统计学意义。门静脉治疗组在基础治疗基础上在超声介入下经皮经肝穿刺至门静脉,注入自体骨髓干细胞治疗;肝动脉治疗组在基础治疗基础上在放射介入下经股动脉插管至肝固有动脉注入自体骨髓干细胞治疗。治疗后第2、4、8周检测两组患者ALT、AST、TBil、凝血酶原活动度(PTA)和白蛋白(Alb)水平变化。同时观察临床症状的改善情况及术后的不良反应。组间比较采用成组t检验,治疗前后比较采用配对t检验,计数资料采用卡方检验。结果门静脉组有22例(88.0%)患者乏力、纳差症状有明显改善,肝动脉组有21例(84.0%),两组间比较差异无统计学意义(P>0.05);治疗后8周,门静脉和肝动脉组患者血清Alb水平分别为(34.4±7.8)g/L和(33.8±8.0)g/L,较治疗前[分别为(27.1±8.9)g/L和(26.8±9.6)g/L]有显著提升(P均<0.05),但两组间差异无统计学意义(P>0.05);两组PTA分别为(58.0±13.1)%和(56.9±12.8)%,较治疗前[分别为(45.5±12.3)%和(47.0±11.6)%]有显著提升(P均<0.05),但两组间差异无统计学意义(P>0.05);血清ALT、AST、TBil在两组间变化差异无统计学意义;两组甲胎蛋白(AFP)分别为(10.3±5.9)ng/ml和(8.9±4.3)ng/ml,差异无统计学意义(P>0.05),未发现严重的不良反应及并发症。结论经门静脉和肝动脉移植自体骨髓干细胞治疗失代偿期肝硬化是一种较安全、有效的方法,两组间疗效相比差异无统计学意义。Objective To conduct a comparative study on the therapeutic effect and safety of autologous bone marrow stem cell transplantation through the portal vein or hepatic artery in the treatment of deeompensated liver cirrhosis. Methods A retrospective analysis was performed on the clinical data of 50 patients with decompensated liver cirrhosis who were hospitalized from December 2006 to May 2012. In addition to basic treatment, 25 of these patients underwent ultrasound - guided percutaneous liver puncture and autologous bone marrow stem cell transplantation through the portal vein （portal vein group）, and the rest underwent radiology -guided femoral artery catheterization and autologous bone marrow stem cell transplantation through the proper hepatic artery （hepatic artery group）. There were no significant differences in baseline conditions between the two groups. At 2, 4, and 8 weeks after operation, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBil）, and albumin （Alb） levels and prothrombin time activity （PTA） were measured, and improvements in symptoms and adverse events were evaluated. Comparisons between the two groups were made by independent -samples t test; comparisons between values before and after treatment were made by paired t test ; categorical data were analyzed by chi - square test. Results Twenty - two cases （ 88.0% ） of the portal vein group showed signif- icant improvements in fatigue and poor appetite, versus 21 cases （84.0%） of the hepatic artery group （P 〉0. 05）. At 8 weeks after operation, the portal vein group and hepatic artery group had serum Alb levels of 34.4±7.8 g,/L and 33.8±8.0 g/L, significantly higher than the values betore operation （27.1±8.9 g/L and 26.8±9.6 g/L） （P 〈 0.05 for both）, but there was no significant difference between the two groups （P 〉 0.05 ） ; the two groups had PTAs of 58.0%±13.1% and 56.9%±12.8%, significantly higher than the values before operation （45.5% ± 12.3

关 键 词：肝硬化 干细胞移植 门静脉 肝动脉 

分 类 号：R575.2[医药卫生—消化系统]