急诊经冠脉自体骨髓单个核细胞移植治疗急性下壁心肌梗死长期随访观察

Long term follow-up on emergent intracoronary autologous bone marrow mononuclear cell transplantation for acute inferior-wall 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单个核细胞(BM-MNC)移植治疗急性下壁心肌梗死后6个月时患者心功能以及心肌缺血面积的变化。方法40例首次ST段抬高急性下壁心肌梗死患者,成功完成PCI术后,随机分为细胞移植组(n=20)和对照组(n=20),在急诊冠状动脉造影术同时,经微导管于梗死相关动脉内支架远端注入自体BM-MNC悬液或等量的肝素生理盐水。研究终点为术后6月时延迟增强核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记录左室射血分数(LVEF)、左室舒张末期容积(LVEDV)及心肌缺血面积的变化,结果显示与术前相比,两组患者LVEF均有显著提高(对照组47·9%±6·7%vs43·4%±6·7%,P=0·001;细胞移植组51·5%±5·2%vs44·5%±7·1%,P=0·001)。但细胞移植组患者LVEF升高程度(△LVEF)增加明显高于对照组LVEF改善程度(6·95%±3·33%vs4·05%±1·68%,P=0·047),且细胞移植组患者心肌缺血面积减少程度优于对照组,两组间左室舒张末容积变化未见明显差别。结论急性下壁心肌梗死患者经冠状动脉内自体骨髓单个核细胞移植,可显著长期改善患者左室收缩功能和心肌灌注,减少心肌缺血面积。

Objective To investigate the effects of emergent intracoronary autologous bone marrow mononuclear cell （BM-MNC） transplantation on left ventricular function and myocardium lesion area in patients with first acute inferior-wall myocardial infarction. Methods Forty patients with first onset of acute inferior-wall myocardial infarction, 28 males and 12 females, aged ≤75, treated with emergent percutaneous coronary intervention （PCI） were randomly divided into 2 equal groups： group undergoing intracoronary transplantation of autologous BM-MNC via a micro-catheter right after PCI （ BM-MNC group）, and control group receiving normal saline and heparin. Blood routine examination, myocardium zymogram, and serum high sensitive C reactive protein （hsCRP） were detected, and 24-hour dynamic electrocardiography, delayed-enhancement myocardial magnetic resonance imaging （CMR）, and angiography of the coronary artery and left ventricle were conducted before the transplantation and immediately, 1 week, and 6 months after transplantation. Results CMR showed that 6 months later the left ventricular ejection fraction （LVEF） of the control group was 47.9% ± 6.7%, significantly higher than that 1 week later （43.4% ± 6.7% ,P =0.001 ）, and the LVEF of the BM-MNC group 6 months later was 51.5% ±5.2%, significantly higher than that 1 week later （44. 5% ± 7. 1%,P =0. 001; however, the absolute change of LVEF （ALVEF） of the BM-MNC group was 6.95% ±3.33% , significantly higher than that of the control group （4.05% ± 1.68% , P = 0. 047 ）. Six months later the myocardial lesion area of the BM-MNC group decreased more significantly in comparison with the control group. Nevertheless, there was no difference in change of left ventricular end diastolic volume （LVEDV） between these two groups. The serum hsCRP 48 h after transplantation of the BM-MNC group was 2.8 g/L ± 0.8 g/L, significantly lower than that before transplantation （13.4 g/L ± 3.6 g/L, P 〈 0. 001 ）. ± No severe clinical events, such death, recurrent cardiac infarction, malignant arrhythmia, occur in these 2 groups. Conclusion Emergent intracoronary transplantation of autologous BM-MNC in patients with acute inferior-wall myocardial infarction improves the left ventricular function and myocardial infusion, minimizes the myocardial lesion area significantly.