自体骨髓干细胞移植治疗急性心肌梗死的临床研究

Clinical study of intracoronary autologous bone marrow stem cells transplantation in treating acute myocardial infarction

目的探讨经皮冠状动脉内移植自体骨髓干细胞治疗急性心肌梗死的可行性与近期临床疗效。方法入选发病12h内行急诊冠状动脉介入治疗(PC I)的急性ST段抬高型心肌梗死患者33名,分为骨髓细胞移植组(n=18)和对照组(n=15),骨髓细胞移植组除常规治疗外,在PC I后1周经皮腔导管技术建立梗死相关动脉通道,用指引导丝将微灌注导管送入支架内后,将分离的骨髓干细胞悬液经微导管中心腔内注入梗死血管远端。对照组仅采用常规治疗,比较2组治疗前后左室射血分数(LVEF)、心肌灌注缺损指数。结果术后6月随访,经胸超声心动图显示移植组和对照组前、后LVEF分别由(46.5±2.3)%、(46.0±3.4)%增加到(48.4±2.5)%、(47.4±3.0)%,但差异均无统计学意义(P>0.05);单光子放射计算机断层显像术(SPECT)显示移植组和对照组心肌灌注缺损指数分别由14.8±3.0、14.6±2.4降低至10.5±1.8、12.8±2.4,前者比后者降低更明显,差异有统计学意义(P<0.05);移植组在移植术中和术后均无并发症发生。结论经皮冠状动脉内移植骨髓干细胞治疗急性心肌梗死安全可行,术后能改善心肌血流灌注,但对左室收缩功能无明显改善。

Objective To study the efficacy and safety of intracoronary, autologous bone marrow stem cells transplantation for acute myocardial infarction（AMI）. Methods 33 patients with acute ST-segment elevation myocardial infarction who were successfully treated with percutaneous coronary intervention（PCI） within 12 hours were divided into two groups（ the bone marrow transplantation group and the control group）. The bone marrow stem cell suspensions were infused into the infarction related artery through infusion catheter one week after PCI. Left ventricular ejection fraction（LVEF） and myocardial perfusion defect scores were determined six months before and after the transplantation. Results Between one week and six months post AMI, LVEF changed from 46. 5 ± 2.3% to 48.4 ± 2.5% in the group of bone marrow transplantation（BMT） which showed no significant difference（ P 〉 0.05 ）. Myocardial perfusion defect scores were decreased significantly from 14. 8±3.0 to 10. 5± 1.8 （ P 〈 0. 05） in the BMT group. Conclusion The present study demonstrated that intracoronary infusion of autologous bone marrow stem cells in patients with AMI is relatively safe and can improve myocardial ischemia.