自体骨髓单个核细胞移植治疗扩张型心肌病的临床观察

Clinical Study of Autologous Bone Marrow Mononuclear Cells Transplantation in Treating Dilated Cardiomyopathy

目的:观察自体骨髓单个核细胞冠脉内移植治疗扩张型心肌病的临床疗效。方法:扩张型心肌病16例(男性5例, 女性11例),平均年龄(45．3±10．8)岁,心功能Ⅳ级,左室射血分数(LVEF)<30％。抽取骨髓,用Ficoll密度梯度离心法分离骨髓单个核细胞,经外周动脉穿刺插管,将骨髓单个核细胞分别直接注入左、右冠脉。比较移植前后心功能的变化。结果:移植3个月后,心功能(NYHA分级)得到改善,总有效率87．5％,超声心动图检查均示左室舒张末径(mm)(72．94± 4．01 vs 63．63±2．58．P<0．001)、左室收缩末径(mm)(52．00±2．80 vs 44．38±1．78．P<0．001)减小,左室射血分数(％) (22．88±5．29vs33．81±3．33,P<0．001)、短轴缩短率(％)(12．00±2．39 vs 20．94±3．70,P<0．001)明显增加;心脏ECT 检查与术前相比,术后患者缺血及坏死心肌节段减少,(3．4±0．3vs2．1±0．4,P<0．05)(2．5±0．5 vs 1．6±0.3,P< 0．01)个。结论:自体骨髓单个核细胞移植有可能通过缺血心肌血运改善,坏死心肌区有心肌细胞再生而改善扩张型心肌病的心功能。

Objective. To investigate the efficacy of intmeoronary transplantation of bone marrow mononuclear cells （BMNCs） for dilated cardiomyopathy. Methods：Sixteen patients with dilated cardiomyopathy were enrolled in this study（male 5, female 11）. The average age was（45.3 ± 10. 8）years old and NYHA cardiac function was grade IV. Bone marrow was aspirated under local anesthesia from ilium and BMNCs were isolated by Fieoll density separation. BMNCs were injected into coronary artery through the catheters. Results： At 3 months follow-up, NYHA classification of patients improved （87. 5 % ）. Left ventricular end-diastolic diameter （LVEDd,mm） （72.94 ± 4. 01 vs 63. 63 ± 2. 58,P 〈 0. 001） and left ventricular end-systolic diameter （LVESd,mm） （52. 00 ± 2. 80 vs 44. 38 ± 1.78, P 〈 0. 001 ）were reduced measured by echoeardiography. Left ventricular ejection fraction （LVEF, % ） （22. 88 ± 5.29 vs 33. 81 ± 3.33, P 〈 0. 001 ） and left ventricular fraction shortening （FS, % ） （12. 00 ± 2. 39 vs 20. 94± 3. 70,P 〈 0. 001） increased markedly. After transplantation,the ischemic and necrotic regions were reduced significantly （2, 1 ± 0. 4 vs 3.4 ± 0. 3, P〈0. 05 ; 1.6 ± 0. 3 vs 2. 5 ±0. 5, P〈0. 01 ）. Conclusion. These results demonstrate that autologous bone marrow mononuclear cell transplantation is relatively safe and feasible in treating dilated cardiomyopathy.