内皮祖细胞移植治疗儿童原发性肺动脉高压的初步探讨

Intravenous infusion of autologous endothelial progenitor cells in treatment of primary pulmonary hypertension

目的探讨内皮祖细胞(endothelialprogenitorcell,EPC)移植治疗儿童原发性肺动脉高压的可行性、安全性和有效性。方法分别将(0.5±0.3)×107内皮祖细胞经右心导管注射于13例原发性肺动脉高压患儿的肺动脉。观察治疗前后6min步行距离及血液动力学参数(平均肺动脉压、心排血量和肺血管阻力)。结果随访3个月,患者行EPC移植治疗后,6min步行距离从(230±56)m增加至(313±65)m(t=3.252,P<0.01);平均肺动脉压从(62±10)mmHg下降至(53±12)mmHg(t=3.213,P<0.01);心排血量从(3.6±1.2)LOmin增加至(4.2±1.1)LOmin(t=3.356,P<0.01);肺血管阻力从(1195±437)dyn.sec.cm-5下降至(905±427)dyn.sec.cm-5(t=3.206,P<0.01)。治疗期间未见明显的与内皮祖细胞移植相关的副作用。结论内皮祖细胞移植治疗儿童原发性肺动脉高压是可行、安全和有效的。

Objective To investigate the feasibility, safety, and initial clinical outcome of intravenous infusion of autologous endothelial progenitor cell （EPC） in children with primary pulmonary artery hypertension. Methods EPC（0.5±0.3×107） were infused at the level of the pulmonary artery by right heart catherterization in 13 PPH children hospitalized. The primary end point for efficacy evaluation was change in the 6-minute walk distance using a standardized protocol. The secondary end points were changes in hemodynamic variables as assessed by right heart catheterization. Results The mean distance in 6-minute walk test increased from（230±56）m to（13± 65）m after 3 months （P〈 0.01）. During the same period, the mean pulmonary arterial pressure declined from（62±10）mmHg to（53±12）mmHg（P〈 0. 01）, cardiac output increased from（3.6±1.2）liters per minute to（4.2±1.1 ）liters per minute, and pulmonary vascular resistance declined from（1195±437）dyn., sec.cm-5 to（905± 427）dyn.sec.cm-5 （P〈0. 01）. There were no severe adverse events with cell infusion. Conclusion Intravenous infusion of autologous EPC appeared to be feasible and safe, and may have beneficial effects on exercise capacity and pulmonary hemodynamics in patients with idiopathic pulmonary arterial hypertension.