自体骨髓干细胞移植治疗失代偿肝硬化优化方案的临床研究  

Clinical study on optimization scheme of autologous bone marrow stem cell transplantation for decompensated cirrhosis

作　　者：安选[1] 钟庆[1] 刘书宏[1] 夏莉娜[1] 王辉[1] 巫贵成[1] 

机构地区：[1]重庆三峡中心医院肝病中心,重庆404000

出　　处：《中国生化药物杂志》2015年第4期97-100,共4页Chinese Journal of Biochemical Pharmaceutics

基　　金：重庆市自然科学基金(csts2012jj A10110);重庆市卫生局(2010-2-357)

摘　　要：目的比较骨髓动员、不同分离方式和注射不同细胞悬液密度对骨髓干细胞治疗效果的影响,进一步优化自体骨髓干细胞移植治疗失代偿期肝硬化的方案。方法 2009年2月~2012年6月选取于重庆三峡中心医院肝病科治疗的23例经常规内科综合治疗无明显疗效的肝衰竭患者行自体骨髓干细胞移植治疗,分离纯化骨髓干细胞,经肝动脉插管植入肝脏,观察植入治疗术前及术后第1、2、3月患者血清丙氨酸氨基转移酶（ALT）、白蛋白（ALB）、凝血酶原时间（prothrombin time,PT）及总胆红素（total bilirubin,TBIL）等主要肝功能指标及临床症状的变化情况,比较骨髓动员、不同分离方式和注射不同细胞悬液密度对治疗效果的影响。结果患者总体治疗情况：与基线水平相比,23例患者治疗1、2、3月白蛋白水平呈逐渐增高趋势（P〈0.05）;胆红素及转氨酶、PT均有下降趋势,但差异无显著统计学意义。与未进行骨髓动员组比较,骨髓动员组患者可获得较高的干细胞密度（P〈0.05）;在改善肝功能指标（ALT、TBIL、ALB、PT）方面差异无统计学意义。不同分离方法对干细胞治疗疗效的影响：使用试剂盒分离方法可显著提高患者白蛋白水平（在治疗后3月开始）;但与普通淋巴细胞分离液法相比,在改善肝脏其他功能（ALT、TBIL、PT）方面差异无统计学意义。不同数量级干细胞密度对干细胞移植治疗疗效的影响：≤1×10^10/L与〉1×10^10/L 2组不同数量级自体骨髓干细胞在改善肝功能指标（ALT、TBIL、ALB、PT）方面差异无统计学意义。结论经肝动脉植入自体骨髓干细胞治疗失代偿期肝硬化安全有效,可显著提高失代偿肝硬化患者白蛋白水平;术前骨髓动员与采用试剂盒的方法可分别提高干细胞的获得率以及改善低蛋白水平,有助于提高治疗疗效。Objective To compare the therapeutic effects of bone marrow stem treatment by different bone marrow mobilization,distinct separation methods or cell suspension density, and to explore the optimal treatment plan of autologous bone marrow stem cell transplantation for decompensated cirrhosis.Methods Twenty three patients with decompensated cirrhosis were studied.100 ~200 mL bone marrow from each patient was harvested in aseptic condition, after isolation and purification by density gradient centrifugation,the stem cells were obtained and transplanted into the liver via hepatic artery.The serum glutamic acid alanine aminotransferase （ALT）, albumin （ALB）, prothrombin time （PT） and total bilirubin （TBIL） were checked before and l, 2, 3 months after therapy respectively,changes in these indicators of each group were compared by different bone marrow mobilization, distinct separation methods, or cell suspension density.Results After transplantation, levels of albumin increased significantly 1, 2, 3 months after treatment compared with baseline（P〈0.05）.Patients in bone marrow mobilization group obtained higher stem cell density （P〈0.05）, which had no significant difference in improving liver function （ ALT, TBIL, ALB, PT） compared with non-bone marrow mobilization group.Patients using the kit significantly improved their albumin （3 months after treatment, P〈0.05）, which had no significant difference in improving liver function （ALT, TBIL, ALB, PT） compared with using ordinary lymphocyte isolation method group.There was no significant difference in improving liver function （ ALT, TBIL, ALB, PT） between lower magnitude stem cell density group（≤1 ×10^10/L） and higher magnitude stem cell density group（1 ×10^10/L）.Conclusion The treatment for decompensated cirrhosis by transplantation of autologous bone nlarrow stem cells is safe and effective, which can significantly increase the level of albumin in patients with decompensated cirrhosis.Preoperative bone marrow mobili

关 键 词：自体骨髓 干细胞移植 失代偿期肝硬化 优化方案 

分 类 号：R783.1[医药卫生—口腔医学]