急性心肌梗死患者外周血干细胞动员效率及安全性观察

The effects and safety of autologous peripheral blood stem cell mobilization by-CSF in patients with acute myocardial infarction

目的 观察急性心肌梗死 (AMI)患者应用G CSF行自体外周血干细胞动员的效率与安全性。方法 我院 2 0 0 3年 11月至 2 0 0 4年 8月收治的 4 5例AMI患者 ,入院后在常规AMI治疗 (药物与介入治疗 )基础上给予包涵体型G CSF ,30 0～ 6 0 0 μg d皮下注射 ,连续 5d ,第 6天经美国Baxter公司生产的CS30 0 0PLUS血细胞分离机 ,分离外周血干细胞 ,然后进行经皮经腔冠状动脉内移植自体外周血干细胞进一步治疗急性心肌梗死。动员前及动员后第 3～ 7天行外周血WBC计数检查 ,经流式细胞仪测定CD34+ 的细胞数量。并在外周血干细胞动员时观察有无不良反应 ,心绞痛或心衰加重等并发症发生 ,及一些少见的并发症 :自发性脾破裂、严重化脓性感染、高凝状态、自身免疫性疾病等发生。结果 在动员前及动员后第 3～ 7天外周血中WBC量分别为 (8.4 2± 2 .5 9)× 10 9 L、(31.2 8± 8.34)× 10 9 L、(35 .2 4± 9.38)× 10 9 L、(37.0 3± 13.0 7)× 10 9 L、(35 .34± 14 .6 8)× 10 9 L、(2 0 .35± 9.2 2 )× 10 9 L ;CD34+ 量分别为 (14 .89± 11.4 6 )× 10 6 、(6 7.78± 5 0 .88)× 10 6 、(12 4 .79± 136 .13)× 10 6 、(2 0 8.92± 2 0 6 .97)× 10 6 、(2 0 6 .10± 184 .5 7)× 10 6 、(6 6 .6 3± 5 6 .5 6 )×

Objective Observed the mobilization effects、 the safety and feasibility of autologous circulating blood stem cell by G-CSF in acute myocardial infarction (AMI). Methods 45 patients with AMI were randomly allocated to receive either inclusive type Granulocyte Colony-Stimulating Factor (G-CSF), to mobilize the stem cell. The patients received the dose of G-CSF 300μg-600μg/day, by hypodermic injection, and the duration of applying G-CSF was 5 days. In the process of the mobilization of the circulating blood stem cell, prior to applying G-CSF and on the 3rd、4th、5th、6th、7th after applying G-CSF, the white blood cell (WBC) and CD34+ cell count in the circulating blood should be observed; and the following side effects also should be paid attention to, such as: bone pain, tetter, fever, gastrointestinal effects( nausea 、vomit、 coprostatis ),deteriorated of angina or heart failure and some rare effects(spontaneous spleen rupture, severe purulent infection, hypercoagulable state, autologous immune diseases). Results Prior to applying G-CSF and the 3rd、4th、5th、6th、7th after applying G-CSF, the counts of WBC were (8.42±2.59)×10 9/L、(31.28±8.34)×10 9/L、(35.24±9.38)×10 9/L、(37.03±13.07)×10 9/L、(35.34±14.68)×10 9/L、(20.35±9.22)×10 9/L;the counts of CD34+ cell were (14.89±11.46)×10 6、(67.78±50.88)×10 6、(124.79±136.13)×10 6、(208.92±206.97)×10 6、(206.10±184.57)×10 6、(66.63±56.56)×10 6;The peak of curve that WBC and CD34 + cell count changed with applying days was on the 5th .The count of CD34 + cell in the circulating blood was positive referent with the count of WBC in the circulating blood(r=0.835);was not reference with age、 sex、body weight、and the onset time of AMI. There were total 17 complications during the mobilization of circulating blood stem cell. The incidence of complications during mobilization is 37.8%(17/45), including bong pain being 15.6%(7/45)、fever being 6.7 %(3/45)、pale being 4.4 %(2/45)、tetter being 4.4 %(2/45)、deterioration of heart failure being 4.4 %(2/45),spleen thrombosis being 2.2 %(1/45).No death happened. Conclusion : In patients with AMI, the mobilized peak of WBC and CD34 + cell counts changed with applying days was at the 5th, and the count of CD34 + cell in the circulating blood was positive referent with the count of WBC in the circulating blood(r=0.940),was negative referent with body weight of patients(r=-0.398). And mobilization of autologous circulating blood stem cell was feasible and safe.