粒细胞集落刺激因子对老年急性心肌梗死患者骨髓干细胞动员效率的临床观察

The effects of gronulocyte colony-stimulating factor on autologous peripheral blood stem cell mobilization in elderly patients with acute myocardial infarction

目的观察粒细胞集落刺激因子（G-CSF）对老年急性心肌梗死（AMI）患者外周血干细胞的动员效率。方法AMI患者20例按年龄分为≥70岁组和〈70岁组，两组均给予包涵体型G-CSF 300-600μg／d皮下注射，连用5d，检查动员前及动员后第3、4、5、6、7d患者外周血白细胞计数，流式细胞仪测定CD34^＋细胞数量，观察动员过程中不良反应发生的情况。结果≥70岁组在动员前及动员后第3、4、5、6、7d外周血中白细胞（×10^9／L）分别为6．75、28．16、34．93、34．40、38．93、21．85，CD34^＋细胞（×10^6／L）分别为6．25、51．10、92．60、109．65、134．69、45．09；〈70岁组白细胞（×10^9／L）分别为8．73、28．21、33．67、33．95、32．93、18．71，CD34^＋分别细胞（×10^6／L）为9．01、71．79、128．54、268．17、249．51、72．25，两组外周血白细胞比较，差异无统计学意义（均为P〉0．05），仅动员后第3d〈70岁组外周血中CD34^＋较≥70岁组有显著增加（P〈0．05）；≥70岁组在动员前及动员后第3、4、5、6、7d外周血中自细胞、CD34^＋显示，在动员后第6d出现高峰。患者外周血中CD34^＋细胞数量与白细胞数量变化呈正相关（r=0．94）。两组不良反应发生情况比较，差异无统计学意义（P〉0．05）。结论老年AMI患者行G—CSF动员安全、可行，外周血中CD34^＋细胞数量与白细胞变化峰值均出现在第6d，且白细胞与CD34^＋细胞数量呈正相关。

Objective To observe the mobilization effects of autologous circulating blood stem cell by granulocyte colony-stimulating factor （G-CSF） in elderly patients with acute myocardial infarction （AMI）. Methods Twenty patients with AMI who received inclusive type G-CSF with the dose of 300-600 μg/d, were allocated to two groups. One was elderly group（≥70 years old）, the other was young group（〈70 years old）. The patients received G-CSF by hypodermic injection for 5 days. In the process of the mobilization of the circulating blood stem cell, the white blood cell（WBC） counts were measured and CD34^＋ cell counts in the circulating blood were determined by flow cytometer, and the complications related to the mobilization also were observed. Results In elderly group, before and the 3rd, 4th, 5th, 6th, 7th day after applying G-CSF, WBC counts（ ×10^9/L）were 6.75, 28.16, 34.93, 34.40, 38. 93, 21.85; CD34^＋cell counts（×10^6）were 6.25, 51.10, 92.60, 109.65, 134.69, 45.09 respectively. In young group, before and the 3rd, 4th, 5th, 6th, 7th day after applying G-CSF, WBC counts（ ×10^9/L） were 8.73, 28.21, 33.67, 33.95, 32.93, 18.71; CD34^＋ cell counts（×10^6/L）were 9.01, 71.79, 128.54, 268.17, 249.51, 72.25 respectively. The WBC and CD34^＋ cell counts changed with CSF-applying days and their curve peaks were at the 6th day in the elderly group, and at the 5th day in young group. CD34^＋ cell counts was positive correlated with white blood cell counts in the circulating blood（r= 0.94）. No severe complications happened. Conclusions In elderly patients with AMI, the stem cell mobilization by G-CSF is effective with. the peak of mobilized white blood cell and CD34^＋ cell counts at the 6th day. CD 34^＋ cell count is positive correlated with white blood cell count in the circulating blood.