自体骨髓间充质干细胞和单个核细胞移植治疗冠心病的临床研究

Clinical research for treatment of coronary heart disease with autologous bone marrow mesenchymal stem cell and mononucleus cell transplantation

目的 研究自体骨髓间充质干细胞 (BMSCs)和单个核细胞 (BMMNCs)经冠状动脉 (冠脉 )移植对冠心病、心肌梗死患者心功能的影响及其安全性。方法 10例冠心病伴心肌梗死患者 ,通过冠脉转运将BMMNCs植入心肌梗死区 ,术前和术后 6个月分别行99mTc MIBI心肌灌注显像、二维超声心动图及动态心电图检查。结果 3例患者因心肌梗死罪犯血管狭窄小于 5 0 %未行经皮冠状动脉介入术 (PCI) ,仅移植干细胞。余 7例患者在梗死相关冠脉开通后注入干细胞。 10例患者二维超声心动图检查示左心室射血分数 (LVEF)较术前平均增加 10 5 % (4 0 %～ 18% ) ,左心室舒张末期内径(LVDd)较术前平均减少 2 2mm(- 4mm～ 8mm) ,99mTc MIBI显示梗死部位心肌灌注明显改善。术中及术后随访 6～ 12月均无心律失常和其它合并症发生。结论 自体BMSCs和MMNCs经冠脉移植治疗冠心病心肌梗死 ,可以抑制左心室重构 ,改善心脏功能。

Objective To evaluate the efficacy and safety of transplantation of autologous bone marrow mesenchymal stem cells (BMSCs) and mononucleus cells (BMMNCs) for treating coronary heart disease. Methods Ten patients who had suffered from coronary heart disease with myocardial infarction, were selected. In 7 patients BMSCs+BMMNCs were transplanted immediately following PCI and 3 patients only accepted transplantation of BMSCs+BMMNCs without PCI. Autologous BMSCs+BMMNCs were isolated and cultured for 2-3 weeks. And (0.9～3.5)×106 BMSCs+1.6～6.1×106 BMMNCs were transplantated through intracoroary way. Cardiac functions were determined by 2-D echocardiography、 technetium- 99m methoxyisobutylisonitrile ( 99m Tc-MIBI) and ECG Holter monitor before and 6 months after the procedure. Results Left ventricular ejection fraction (LVEF) was significantly increased by 10.5% (4.0%-18.0%) and left ventricular diastolic diameter(LVDd) reduced by 2.2 mm (-4 mm-8 mm) and neither obvious arrhythmia nor complication was observed during the 6-12 months′ follow up in all the 10 patients. Conclusion The preliminary study showed that in the patients who suffered from coronary heart disease complicated with myocardiac infarction, transplantation of BMSCs+BMMNCs could improve cardiac function and cardiac perfusion without significant complication and arrhythmia during the 6-12 months′ follow-up.