自体外周血CD34＋造血干细胞移植治疗晚期肝硬化的远期疗效  

Long-term outcome of autologous peripheral blood CD34＋ hematopoietic stem cell transplantation in the treatment of advanced liver cirrhosis

作　　者：骆乐[1] 薛华[1] 罗兰云[1] 姚豫桐[1] 邹海波[1] 王冠[1] 向光明[1] 魏玲玲[1] 杨卯竹[1] 张天[1] 谢坪[1] 徐钢[1] 邓绍平[1] 黄孝伦[1] 

机构地区：[1]四川省医学科学院四川省人民医院肝胆胰脾外科中心细胞移植中心,成都610072

出　　处：《中华消化外科杂志》2016年第7期709-714,共6页Chinese Journal of Digestive Surgery

基　　金：国家科技部重点基础研究发展计划（973计划）项目（2015CB964703）;四川省科技厅成果转化支持项目（14010127）

摘　　要：目的 探讨自体外周血CD34＋造血干细胞移植治疗晚期肝硬化的远期临床疗效.方法 采用回顾性横断面研究方法.收集2010年7月至2015年7月四川省人民医院收治的42例晚期肝硬化患者的临床病理资料.患者行自体外周血CD34＋造血干细胞移植治疗：每日皮下注射集落刺激因子5μg/kg,治疗3～5d,采集外周血干细胞,采集的干细胞行流式细胞检测CD34＋造血干细胞数量达（1.8±1.7）×10^6/kg.采集后第2天在DSA检查下行经股动脉超选肝动脉植入术或手术经胃网膜右静脉置管至门静脉主干注入,术中监测门静脉压力.术后积极降低门静脉压力,保护肝肾功能;第3天给予抗凝治疗,防止门静脉系统血栓形成.观察指标：（1）治疗情况：CD34＋造血干细胞移植后患者基本情况、术后并发症.（2）随访情况：患者生存率、肝功能Child评分、终末期肝病模型（MELD）评分、肝脏活组织病理学检查结果、组织学Knodell评分、慢性肝病健康相关生存质量（HRQL）评分.采用门诊、电话及邮件方式随访,随访内容为检查患者肝肾功能、凝血功能;B超及CT检查患者腹腔积液情况;行肝功能Child及MELD评分;行B超引导下肝脏穿刺取活组织检查;调查患者慢性肝病生存质量.随访时间截至2015年7月.正态分布的计量资料以-x±s表示,组间比较采用配对设计t检验.偏态分布的计量资料以M（范围）表示.采用Kaplan-Meier法绘制生存曲线.结果 （1）治疗情况：42例患者经自体外周血CD34＋造血干细胞移植治疗后,患者精神、睡眠、食欲、大小便情况及症状均有不同程度改善.10例患者发生术后并发症,其中上消化道大出血3例,Ⅰ度肝性脑病3例,术后1个月及3个月各发生肝肾综合征1例均死亡,术后6个月发生门静脉血栓1例,自发性腹膜炎1例,其余患者经对症支持治疗后治愈或好转.（2）随访情况：42例患者获得随访,随访中位时间为5Objective To investigate the long-term outcome of autologous peripheral blood CD34＋hematopoietic stem cell transplantation in the treatment of advanced liver cirrhosis.Methods The retrospective cross-sectional study was adopted.The clinical data of 42 patients with advanced liver cirrhosis who were admitted to the Sichuan Provincial People＇s Hospital between July 2010 and July 2015 were collected.The patients underwent autologous peripheral blood CD34 ＋ hematopoietic stem cell transplantation.The 5 μg/kg colonystimulating factors were injected subcutaneously daily for 3-5 days.The peripheral blood stem cells were collected and detected by flow cytometry,showing （1.8 ± 1.7） × 10^6/kg of CD34 ＋ cell.Transfemoral superselective hepatic arterial implantation or catheterization via right gastroepiploic venous to main portal vein （PV） was performed by digital subtraction angiography （DSA） at 2 days after collection,and intraoperative portal venous pressure （PVP） was monitored.PVP was reduced after operation and liver and renal functions were protected.The patients underwent anticoagulation therapy at 3 days for preventing PV thrombosis.Observation indicators included （1） treatment：the basic conditions of patients after CD34 ＋ hematopoietic stem cell transplantation and postoperative complications,（2） follow-up：survival rate of patients,Child score,model for end-stage liver disease （MELD） score,result of biopsy,Knodell score and health related quality of life （HRQL） score.The follow-up using outpatient examination,telephone interview and Email was performed to detect the liver and renal functions and coagulation function up to July 2015.Peritoneal effusion of patients was detected by B ultrasound and computed tomography （CT） examination.The patients received liver function Child-Pugh score,MELD score,percutaneous transhepatic biopsy guided by B ultrasound and HRQL score.Measurement data with normal distribution were presented as x ± s,comparison between groups was an

关 键 词：终末期肝病 肝硬化 自体外周血CD34^+造血干细胞 终末期肝病模型 慢性肝病健康相关生存质量评分 

分 类 号：R575.2[医药卫生—消化系统]