骨髓液采集操作技术对自体骨髓干细胞移植质与量的影响

Influences of bone marrow collection technology on the quality and quantity of autologous bone marrow stem cell transplant

目的:探讨骨髓液采集操作技术对自体骨髓干细胞移植过程中细胞数量的影响,并分析其与疗效的关系。方法:以唐山市工人医院2004-09/2005-06收治的11例心肌梗死骨髓干细胞移植患者为常规对照组,以2005-06/2006-04收治的15例心肌梗死骨髓干细胞移植患者为技术操作组,两组患者性别、年龄、病程等基线资料比较差异无显著性意义(P>0.05),均经医院伦理委员会批准并获得患者知情同意。两组患者均行骨髓干细胞移植,手术前后根据临床需要给予标准药物治疗,术后进行抗炎、抗凝及显微外科常规护理。此外,技术操作组在骨髓采集、保存、净化处理过程中给予以下相应的干预措施:①严格执行无菌操作,控制采集时的压力。②控制溶血和凝集。③防止外周血混入。④控制骨髓干细胞存储的温度和时间。两组分别于术前及术后3,6个月,采用多普勒超声心动图测定患者左室射血分数;并行核素心肌灌注断层显像,观察心肌灌注稀疏缺损区占心肌的比例;6min步行试验。结果:常规对照组11例患者与技术操作组15例患者均进入结果分析。①两组骨髓液中分离单个核细胞数量和术后并发症情况:技术操作组采集的骨髓液中单个核细胞数明显高于常规对照组(1.5×109个,1×109个,P<0.05)。技术操作组发生骨髓液标本凝集、溶血、混血、迷走神经反射、血管急性闭塞例数明显少于常规对照组(P均<0.05)。②两组手术前后心功能指标及6min步行实验检测结果:术前两组心功能指标及6min步行距离均基本相似(t=0.86～1.94,P均>0.05)。术后3,6个月,技术操作组多普勒超声测定左室射血分数、心肌双核素检查左室射血分数均明显好于常规对照组(t=2.12～3.13,P均<0.05),6min步行距离无明显变化(t=1.92～1.94,P均>0.05)。结论:自体骨髓液的采集过程中,采取控制骨髓采集压力,防止溶血、凝血及混入外周血,控制骨髓液的存储温度和时间等干预,能够保证移植骨髓液的有效干细胞数量,减少并发症,提高骨髓干细胞移植疗效。

AIM： To explore the effect of technology handle characteristic of blood collection on cell quantity in autologous bone marrow stem cell transplantation and analyze the relation with curative effect. METHODS： Totally 11 patients with myocardial infarction who had been treated by autologous bone marrow stem cell transplantation in Tangshan Worker＇s Hospital from September 2004 to June 2005 were selected for the routine control group and 15 patients with same disease and treatment from June 2005 to April 2006 were selected for the technology operation group. The difference of fundamental data of two group patients＇ sex, age, disease course was not significant（P 〉 0.05）. All of the treatment had been passed by the Hospital Ethics Committee and all of the patients had known the facts and agreed. Two groups were treated by bone marrow stem cell transplantation and standard medication according to the needs of clinic before and after operation. After operation, anti-inflammatory and anticoagulation and routine nursing of microsurgery were performed. Moreover, the technology operation group adopted following interfere methods in the courses of collection, preservation, purification of bone marrow solution： （1）to carry out sterile technology and control pressure during collection strictly, （2）to avoid hemolysis and agglutination, （3）to prevent the peripheral blood from interfusion, （4）to control the temperature and time of bone marrow stem cell preservation. Doppler echocardiography was used to measure the left ventricular ejection fraction, and Nuclide myocardial perfusion image was used to explore the proportion of cardiac pour sparse defect area to myocardium, and Six-minute-walk test were performed in two groups before operation and 3 and 6 months after operation, respectively. RESULTS： A total of 11 cases of routine control group and 15 cases of technology operation group were analyzed. （1） Numbers of mononuclear cells separated and complications in two groups： Numbers of mononuclear cells collected of technology operation group were more than that of routine control group （1.5×10^9,1×10^9, P 〈 0.05）. Numbers of hemolysis, agglutination, blood interfusion, pneumogastric nerve reflection and acute blood vessel block-up of technology operation group were obviously less than that of routine control group （P 〈 0.05）. （2）Results of heart function index and Six-minute-walk test of two groups before and after operation： Heart function index and Six-minute-walk distance of two groups before operation were similar （t =0.86-1.94,P 〉 0.05）. The left ventricular ejection fractions measured by Doppler echocardiography and cardiac double nuclide test were markedly both better in the technology operation group than the routine control group at months 3 and 6 after operation （ t =2.12-3.13, P 〈 0.05）and Six-minute-walk distance was no significant difference（ t =1.92-1.94, P 〉 0.05）. CONCLUSION： Interferences of controlling pressure during collection strictly, avoiding hemolysis, agglutination, peripheral blood interfusion and controlling the proper temperature and time of bone marrow stem cell preservation can ensure the effective numbers of bone marrow stem cell for transplantation, reduce complications and enhance curative effect of transplantation during autologous bone marrow collection.