自体骨髓干细胞移植和粒细胞集落刺激因子动员自体骨髓干细胞治疗急性心肌梗死的疗效比较

Comparison of the effects of intracoronary autologous bone marrow mononuclear cell transplantation and stem cell mobilization induced by granulocyte-colony stimulating factor to treat acute ST-Elevation myocardial infarction

目的采用前瞻性随机对照研究方法,评价经冠状动脉自体骨髓干细胞移植和静脉注射粒细胞集落刺激因子(Granulocyte-colony stimulating factor,G-CSF)动员自体骨髓干细胞两种方法治疗急性心肌梗死(acute myocardial infarction,AMI)后6个月时患者心功能和心肌梗死面积的改善情况。方法 40例AMI患者随机分成移植组和动员组两组,移植组在急诊冠脉造影的同时,经微导管与梗死相关动脉内支架远端注入自体骨髓干细胞悬液,动员组在术后24小时内静脉滴注G-CSF10μg/(kg·d)+生理盐水100ml,每天1次,共5天。每例患者均在术后1周和6个月接受超声心动图和延迟增强磁共振心肌灌注扫描(CMR)测定左室功能和心肌缺血面积。结果 CMR测定左室射血分数(LVEF)、梗死面积的变化,结果提示两组LVEF术后6个月较之前都有显著提高[移植组(46.80±11.01)︰(54.42±12.08),动员组(48.69±12.41)︰(52.18±10.05)],且梗死面积都有缩小[移植组(21.96±2.04)︰(17.33±2.14),动员组(38.57±29.38)︰(34.07±25.09)],但两组变化差别无显著意义(P>0.05)。结论自体骨髓单个核细胞移植和G-CSF动员自体骨髓干细胞两种方法改善AMI患者左心功能差别无显著意义。

Objective To compare the effects of intracoronary autologous bone marrow mononuclear cell transplantation and stem cell mobilization induced by granulocyte-colony stimulating factor to treat the acute ST-elevation myocardial infarction.Methods Forty patients with onset of acute ST-elevating myocardial infarction,treated with emergent percutaneous coronary intervention(PCI) ,were divided into 2 equal groups:group 1 undergoing intracoronary transplantation of autologous BM-MNC via amicrocatheter right after PCI,and group 2 undergoing injected with G-CSF [10 μg/(kg·d) ] for 5 days after the PCI.Blood routine examination,myocardium zymogram were detected,and delayed-enhancement myocardial magnetic resonance imaging(CMR) ,and echocardiography were conducted 1 week and 6 months after PCI.Results CMR showed that 6 months later the left ventricular ejection fraction(LVEF) of the group1 were 54.42%±12.08%,that of group 2 were 52.18%±10.05%,echocardiography showed that 6 months later the LVEF of the group 1 were 58.64%±9.66%,that of group 2 were 63%±8.01%.Nevertheless,there was no difference in change of left ventricular ejection between these two groups.Conclusion There was no significant difference in the effects between intracoronary transplantation of autologous BM-MNC and stem cell mobilization induced by granulocyte-colony stimulating factor to improve the left ventricular function of acute myocardial infarction.