自体骨髓干细胞移植治疗心肌梗死患者心肌代谢及收缩功能的变化

Impact of autologous mononuclear bone marrow cells transplantation on early and med-term outcomes on the cardiac function and myocardial metabolic in patients with myocardial infaction

目的：探讨自体骨髓间充质干细胞（BMSCs）和单个核细胞（BMMNCs）经梗死相关冠状动脉（IRA）移植对冠心病心肌梗死患者近、中期心功能、心肌代谢的影响及其安全性。方法：对14例冠心病伴心肌梗死史1-35个月的患者。细胞移植组8例，通过冠脉系统将BMSCs和BMMNCs植入心肌梗死区，余6例常规治疗。两组患者均于术前和术后3，8个月行SPECT双核素心肌显像、二维超声心动图、6min步行试验及动态心电图检查。结果：移植组患者在梗死相关冠脉开通后注入干细胞，8例心功能从Ⅱ-Ⅳ级提高至Ⅰ-Ⅱ级，6min步行试验从（320．72±60．47）m提高至（406．88±68．31）m，6个月后又提高至（484．79±81．00）m。6例前壁心梗患者3，8月后LVEF由术前的42．5％提高至49．5％和54％；术后3，8月心肌双核素检查缺损区占整个心肌体积由术前的45．5％减少至39％和25％。6例对照组患者术后3月EF较术前提高，心肌双核素检查缺损区占心肌体积减少，术后8月与术后3月无明显改变。2例下壁心肌梗死患者经干细胞移植临床效果不明显。结论：自体BMSCs和BMMNCs经冠脉移植治疗冠心病心肌梗死，可以显著改善前壁心肌梗死患者左室收缩功能和心肌代谢。

Objective： To evaluate the early and med-term outcomes of trans- plantation of autologous bone marrow mesenchymal stem cell（BMSCs） and monoucleus cells （BMMNCs） for treating coronany heart disease. Methods： Fourteen patients who had suffered from coronary heart disease with myocardial infarction , were enrolled in this prospective, nonrandomized , control study （8 patients in cell transplantation group;6 in control group） . Autologous BMSCs ＋ BMMNCs were transplanted into the myocardial infracted area in the cell transplantation group through intracoronary way. All patients underwent 3-month and 8-month follow-up,6 minutes test, 2D Doppler echocardiogram, SPECT. Results： After 3 months and 8 months follow-up,cardiac function were improved ：6 minuts distance was prolonged from 320.72 ±60.47 m to 406.88 ±68.31 and 484.79 ±81.00 m. left ventricular ejection fraction （LVEF） was increased by 49. 5% and 54% vs 42.5% , the infarct defected regions was redused by 39% and 25% vs 45.5% before transplantation in 6 patients with anterior myocardial infarction. In control group , 2D Doppler echocardiogram, SPECT were improved in 3 mounths but not improved further in 8 mounths after PCI . In cell transplantation group 2 patients with inferior myocardial infarction was not changed significactly. Conclusion： The preliminary study showed that in the patients who suffered from coronary heart disease compliated with anterior myocardial infarction, transplantation of BMSCs ＋ BMMNCs could improve cardiac ruction and cardiac metabolism.