自体骨髓干细胞治疗终末期肝病24例临床观察

Therapeutic efficacy of autologous bone marrow stem cells transplantation for treatment of terminal liver disease of 24 cases

目的探讨自体骨髓干细胞移植对肝衰竭及肝硬化失代偿期患者的治疗作用。方法 24例终末期肝病患者无菌抽取骨髓180～200 ml,用负收集法分离提取骨髓血干细胞,然后经肝动脉导管注入肝脏。术后定期检测肝功能、凝血功能、甲胎蛋白、肝脏储备功能、肝脏超声和肝脏CT,并观察同期的症状体征和不良反应情况。结果与术前比较,术后2周时ALT即明显下降,差异有统计学意义;Alb、CHE、PTA、AFP于术后4、8及12周增高明显,与术前相比,差异有统计学意义;TBil、吲哚青绿15 min滞留率(ICGR15%)于术后12周时明显下降,与术前相比,差异有统计学意义;术后12周时肝脏CT,其门脉一级分支平面面积与术前相比增加,差异有统计学意义。干细胞移植术后,所有患者精神、体力、食欲明显好转,均未发现细胞移植并发症。结论自体骨髓干细胞移植治疗终末期肝病近期安全有效,患者肝功能、凝血功能、肝脏储备功能改善明显,缩小的肝脏有所增大。

Objective To study the effect of autologous bone marrow stem cells(BMSCs) transplantation in the treatment of liver failure and decompensated hepatic cirrhosis.Methods Stem cells were harvested from patients' bone marrow(180-200 ml) by negative collecting method.The stem cells were infused into the liver through hepatic artery.At different time points,the patients liver function,prothrombin activity(PTA),AFP,liver reserving function,namely indocynine green retention rate at fifteen minutes(ICGR15%),liver ultrasound and liver CT were detected.Symptoms and adverse reactions were observed at the same time.Results The serum alanine aminotransferase(ALT) levels were significantly declined after transplantation(P<0.05);The serum albumin(Alb)、PTA、cholinesterase(CHE) and AFP levers were significantly increased at 4 weeks、8 weeks and 12weeks after transplantation(P<0.05);The serum total bilirubin(TBil)、ICGR15% were significantly declined at 12 weeks after transplantation(P<0.05);and surface area of a branch of the portal were significantly increased at 12 weeks after transplantation(P<0.05);After transplantation,all patients' mental、physical strength and appetite were improved,and no complications associated with the transplantation occurred.Conclusion BMSCs transplantation are safe and effective,and can significantly improve the liver function、coagulation and liver reserving function,the size of reduced and increase reduction of liver size.