自体骨髓间充质干细胞治疗乙型肝炎失代偿期患者:肝纤维化、肝功能、MELD评分及1年生存率分析  

Therapeutic effect of autologous bone marrow mesenchymal stem cells on hepatic fibrosis,liver function,MELD score and 1-year survival rate in patients with decompensated hepatitis B

作　　者：吴玉卓[1] 杨乐[2] 翟玉峰[1] 张怀宏[1] 霍丽亚[1] 

机构地区：[1]郑州大学附属医院南阳市中心医院感染科,河南省南阳市473000 [2]南阳医学高等专科学校基础医学部,河南省南阳市473000

出　　处：《中国组织工程研究》2017年第13期2049-2055,共7页Chinese Journal of Tissue Engineering Research

基　　金：河南省卫生厅科研成果(宛科鉴字[2012]第103号99)~~

摘　　要：背景:骨髓间充质干细胞在特定环境下可分化成肝干细胞,参与肝功能的修复和重建。目的:分析自体骨髓间充质干细胞移植治疗失代偿期乙型肝炎的效果。方法:将84例乙型肝炎失代偿期患者随机分为2组,常规组(n=42)采用对症治疗,同时口服恩替卡韦、扶正化瘀胶囊;干细胞组(n=42)在常规组治疗的基础上,经肝左右动脉移植自体骨髓间充质干细胞1×106/kg。治疗前及治疗后12,24周,检测肝纤维化、肝功能及终末期肝病模型系统评分,统计患者1年生存率。结果与结论:(1)肝纤维化:两组治疗后的透明质酸、层粘连蛋白、Ⅲ型前胶原、Ⅳ型胶原蛋白水平均低于治疗前(P<0.05);干细胞组治疗后12,24周的上述指标均低于常规组(P<0.05);(2)肝功能:两组治疗后的丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素水平均低于治疗前(P<0.05),白蛋白、胆碱酯酶、凝血酶原活动度水平均高于治疗前(P<0.05);干细胞组治疗后12,24周的丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素水平均低于常规组,胆碱酯酶水平高于常规组(P<0.05);(3)终末期肝病模型系统评分:两组治疗后的终末期肝病模型系统评分均低于治疗前(P<0.05),干细胞组治疗后24周的终末期肝病模型系统评分低于常规组(P<0.05);(4)1年生存率:干细胞组1年生存率高于常规组(50%,69%,P<0.05);(5)结果表明:采用自体骨髓间充质干细胞移植治疗失代偿期乙型肝炎,能够显著改善肝纤维化状态和肝功能,提高患者1年生存率。BACKGROUND：Bone marrow mesenchymal stem cells can differentiate into hepatic stem cells in a specific environment, and participate in the repair and reconstruction of liver function.OBJECTIVE：To investigate the therapeutic effect of autologous bone marrow mesenchymal stem cell transplantation on decompensated hepatitis B.METHODS：Eighty-four patients with decompensated hepatitis B were randomly divided into two groups：normal group （n=42） with symptomatic treatment, and oral entecavir, Fuzheng Huayu Capsule; stem cell group （n=42） with the left and right hepatic artery transplantation of autologous bone marrow mesenchymal stem cells （1×10^6/kg） based on conventional treatments. Degree of liver fibrosis, liver function and score on Model for End-Stage Liver Disease （MELD） system, 1-year survival rate of patients were detected and analyzed with statistics before and 12, 24 weeks after treatment.RESULTS AND CONCLUSION：（1） Liver fibrosis after treatment in two groups：hyaluronic acid, laminin, type Ⅲ collagen and type IV collagen levels after treatment were lower than those before treatment in both two groups （P 〈 0.05）, while these indexes in the stem cell group were lower than those in the normal group at 12 and 24 hours after treatment （P 〈0.05）. （2） Liver function：after treatment, decreased alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels were found in both two groups （P 〈 0.05）, and albumin, cholinesterase, prothrombin activity levels were higher than those before treatment （P 〈 0.05）. The alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels in the stem cell group were lower than those in the normal group at 12 and 24 weeks after treatment, while the cholinesterase level was higher in the stem cell group （P 〈 0.05）. （3） MELD scores：MELD scores were both decreased in the two groups after treatment （P 〈 0.05）, and lower in the stem cell group compared with the normal group at

关 键 词：干细胞 移植 乙型肝炎 失代偿期 间质干细胞移植 恩替卡韦 扶正化瘀胶囊 治疗结果 

分 类 号：R394.2[医药卫生—医学遗传学]