摘要
目的研究自身骨髓间质干细胞经冠脉内移植治疗近期陈旧性心肌梗死伴心功能不全的临床疗效及安全性。方法将本院22例近期陈旧性心肌梗死伴心功能不全患者,随机分为对照组和移植组各11例,两组均予常规药物治疗,移植组给予自身骨髓间质干细胞经梗死相关冠脉内移植,对照组经冠脉注射等量生理盐水。术前、术后48 h、3个月和6个月分别检测血清IL-6、TNF-α和CRP,术前、术后3个月和6个月分别观察血浆BNP、6 min步行试验、超声心动图、动态心电图9、9 mTc-甲氧基异丁基异腈(MIBI)和18F-脱氧葡萄糖(FDG)双核素心肌显像。结果细胞移植组术前、术后48 h、3个月和6个月血清IL-6、TNF-α和CRP与对照组比较差异均无显著性(P>0.05)。术后3个月和6个月,与对照组比较,细胞移植组BNP降低,6 min步行试验增加,与自身术前比较差异亦具显著性,P<0.05。术后3月,细胞移植组左室射血分数增加,与对照组和自身术前比较差异有显著性[(0.40±0.03)vs.(0.37±0.09),(0.35±0.05),P<0.05)。术后6月,细胞移植组左室舒张末容积缩小,与对照组和自身术前比较差异有显著性(4.97±0.54)vs.(5.63±0.80),(5.84±0.75)cm,P<0.05]。双核素心肌显像提示,移植组术后6个月灌流-代谢不匹配节段数增加,与对照组和自身术前比较差异具显著性[(7.60±1.26)vs.(6.20±1.14),(5.80±1.69)个,P<0.05]。围手术期及术后6个月随访中未见任何严重致心律失常发生。结论自身骨髓间质干细胞经冠脉内移植治疗陈旧性心肌梗死伴心功能不全患者,可能改善心功能,延缓心室重塑,增加存活心肌,无明显的致心律失常和免疫炎症反应。
Objective Recent experimental and clinical observations have suggested that cell transplantation could be of therapeutic value for the treatment of heart failure. This study was performed to explore the effect and safety of percutaneous coronary autologous mesenchymal stem cells （MSCs） injection in the treatment of patients with old myocardial infarction and cardiac dysfunction. Method Twenty-two patients with old myocardial infarction and impairment were enrolled and treated with standard medicines, then randomly divided into two groups, intracoronary injection of MSCs （ n = 11） and saline （control group, n = 11）. Serum levels of ID6, TNF-a and CRP, plasma levels of brain natriuretic peptides （BNP）, echocardiogram, dynamic electrocardiogram, six minutes trial walk, myocardial perfusion imaging by ^90mTc-MIBI SPECT and metabolic imaging by ^18F-FDG SPECT were all done at the designed time intervals until six months after transplantation of MSCs or injection of saline. Results The concentrations of IL-6, TNF-α and CRP showed no significant differences at 48 hours, 3 months and 6 months after transplantation compared with control and pre-transplantation （ P 〉 0.05）. The plasma levels of BNP were decreased and six-minute-walk elevated significantly in the MSCs patients after 3 months and 6 months compared with that of pre-transplantation and the control group （ P 〈 0.05）. Left ventrieular ejection fraction （LVEF） three months after transplantation in MSCs group increased significantly compared with that of preimplantation and with that of the control group at three months post-injection [ （0.40 ± 0.03） vs （0.35 ± 0.05） and （0.37 ± 0.09）, P 〈 0.05, respectively]. The sizes of LVEDd obtained from echocardiogram were reduced significantly after six months in the MSCs group, P 〈 0.05, but not in the control group, P 〉 0.05,^99mTc-MIBI/18F-FDG dual-isotope imaging results showed that mismatching segments were increased significantly in MSCs group at 6-month follow-up
出处
《中华急诊医学杂志》
CAS
CSCD
2005年第12期996-999,共4页
Chinese Journal of Emergency Medicine
关键词
骨髓间质干细胞
陈旧性心肌梗死
心功能不全
经皮冠脉内细胞成形术
Mesenchymal stem cells
Old myocardial infarction
Cardiac dysfunction
Percutaneous coronary cellular cardiomyoplasty
