摘要
【目的】探讨异体骨髓间充质干细胞治疗慢加急性乙肝肝衰竭患者合适时机。【方法】91例慢加急性乙肝肝衰竭患者分为两大组,干细胞治疗组45例,其中进展期12例,平台期33例;对照组46例,进展期13例,平台期33例。首要研究终点是比较12周不同组不同期患者生存状况;次要研究终点是观察干细胞治疗组患者与对照组患者不同时点的胆红素、终末期肝病模型(MELD)评分变化情况。【结果】与对照组相比,疾病进展期患者12周累积生存率(6/12,50%)与对照组进展期患者生存率(6/13,46.2%)比较无统计学差异(P=0.202),疾病平台期患者12周累积生存率(28/33,84.8%)较对照组平台期患者生存率(18/33,52.2%)高(P=0.0037)。在干细胞治疗组中,疾病进展期患者12周累积生存率较疾病平台期患者12周累积生存率低,且有统计学差异(P=0.009)。干细胞组平台期患者总胆红素(μmol/L)在2周、4周较基线变化分别为-97±124、-189±166,而进展期患者在2周、4周较基线变化分别为10±206、-10±275,差异有统计学意义(P2w=0.040;P4w=0.013)。平台期患者MELD评分在4、12周较基线变化分别为-3.8±4.5、-12.5±5.1,而进展期患者在4、12周较基线变化分别为3.8±8.1、-4.7±5.3,差异有统计学意义(P4w=0.000;P12w=0.005)。【结论】在慢加急性乙肝肝衰竭疾病平台期进行异体骨髓干细胞移植可以提高患者的生存率。
[Objective]To investigate the best time for the patients with HBV acute-on-chronic liver failure to undergo allogeneic bone marrow mesenchymal stem cells transplantation.[Methods] A total of 91 inpatients with HBV related acute on chronic liver failure （HBV-ACLF） were recruited and randomized into two groups：MSC-treatment group （n =45） and control group （n =46）.45 patients who received bone marrow mesenchymal stem cells （BM-MSC） transplantation were divided into two subgroups：MSC-advanced group （n =12） and MSC-plateau （n =33）; 46 patients as control group received standard medical treatment were divided into two subgroups：Control-advanced （n =13） and Control-plateau （n =33）.Primary endpoint include 12 weeks cumulative survival rate in different treatment phase of MSC groups and control groups,and the secondary endpoints are changes of MELD scores and serum total bilirubin in different groups and subgroups.[Results] The 12-week cumulative survival rate of the patients was slightly increased in MSC-advanced group （6/12,50%）,but not significantly different than that in control-advanced group （6/13,46.2%）（P =0.202）.And the 12-week cumulative survival rate of patients in MSC-plateau group （28/33,84.8%） was much higher than that of patients in control-plateau group （18/33,52.2%） （P =0.0037）.Within the MSC treatment groups,the 12-week cumulative survival rate in MSC-plateau group （84.8%,28/33） was greater than that of MSC-advanced group （50%,6/12） （P =0.009）.Serum total bilirubin levels of patients in the MSC-plateau group improved from baseline in 2,4 weeks were （-97 ± 124）μmol/L,（-189 ±166） μmol/L while there were （10 ± 206）μmol/L,（-10 ± 275）μmol/L in MSC-advanced group.MELD scores of patients in the MSC-plateau group improved from baseline in 4 and 12 weeks were （-3.8 ± 4.5） and （-12.5 ± 5.1） while there were （3.8 ± 8.1）and （-4.7±5.3） in MSC-advanced group.[Conclusion] Operating allogeneic peripheral
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2013年第3期422-428,共7页
Journal of Sun Yat-Sen University:Medical Sciences
基金
"十一五"国家重大专项(2008ZX10202)
"十二五"国家科技重大专项
(2012ZX10002004)
广东省科技计划项目(2007B060401001)
广东省自然科学基金(9151040701000019)
关键词
骨髓间充质干细胞
慢加急性肝衰竭
乙型肝炎
bone marrow mesenchymal stem cells
acute-on-chronic liver failure
hepatitis B virus
