左心室成形术结合骨骼肌成肌细胞移植治疗心肌梗死后心力衰竭

Surgical left ventricular repair combined with skeletal myoblast transplantation for ischemic congestive heart failure after myocardial infarction

目的:探讨左心室成形术结合骨骼肌成肌细胞移植对心肌梗死后充血性心力衰竭的治疗作用。方法:48只心梗后4周的大鼠随机分为4组,组Ⅰ(n=10)在梗死区两侧边缘注射PBS;组Ⅱ(n=11)注射骨骼肌成肌细胞;组Ⅲ(n=13)行左心室成形术,同时注射PBS;组Ⅳ(n=14)行左心室成形术同时注射骨骼肌成肌细胞。分别在术后第1、2、3、4周超声随访心功能。结果:左室舒张末期内径(EDD)与收缩末期内径(ESD)值在组Ⅲ和组Ⅳ于术后1周时明显减小,然后有逐渐增大的趋势,到第4周时,组Ⅲ与组Ⅰ、Ⅱ已没有显著差别,而组Ⅳ仍小于其他3组,差异有非常显著意义(P<0.01);反映左室收缩功能的EF值在组Ⅲ、组Ⅳ于术后1周时达到最高,然后逐渐降低,到第4周时,组Ⅳ的EF大于组Ⅰ、Ⅱ、Ⅲ,差异有显著意义(P<0.01)。结论:在左心室成形术的同时进行骨骼肌成肌细胞移植,可以加强手术的疗效,延缓心室的再次扩大和心功能的再次恶化。

Objective： To evaluate the therapeutic effect of combined procedure of surgical left ventricular repair （LVR） and skeletal myoblast transplantation for congestive heart failure after myocardial infarction. Methods, Forty eight male adult Lewis rats, with a four week old myocardial infarction created by left coronary artery ligation, were randomized into 4 groups： group I （n=10） received phosphate-buffered saline （PBS） injection into the border zone of the infarction ; group Ⅱ （n = 11） received myoblast injection ; group Ⅲ （n=13） received left ventricular repair and simultaneous PBS injection; and group Ⅳ （n=14） received left ventricular repair and myoblast injection. Echocardiography was performed once a week until the fourth week after the treatment. Results： Left ventricle end diastolic diameter （EDD） and end systolic diameter （ESD） declined significantly one week after the LV repair in group Ⅲ and Ⅳ, then increased as time passed; on the fourth week, there were no statistical differences between group Ⅰ,Ⅱ and Ⅲ , but group Ⅳ was still much smaller than the other 3 groups（P〈0.01）. Ejection fraction, which reflects I.V systolic function, was improved apparently after LV repair in Group Ⅲ and Ⅳ, then deteriorated slowly; on the fourth week, group Ⅳ was significantly higher than groupⅠ, Ⅱ and Ⅲ （P〈0.01）. Conclusion： Transplantation of skeletal myoblast combined with left ventricular repair can improve the outcome of surgery by alleviating the re-dilation of the LV chamber and protecting heart function.