经冠脉自体骨髓单个核细胞移植对陈旧性心肌梗死疗效及安全性的观察

The curative effect and security for old myocardial infarction by intracoronary autologous bone marrow mononuclear cells transplantation

目的观察经冠脉自体骨髓单个核细胞（ABM-MNCs）移植对陈旧性心肌梗死（OMI）的疗效及安全性。方法采用前瞻性的单盲随机安慰剂对照的临床研究方法,从2004年7月-2006年3月,严格筛选出27例OMI（心肌梗死距此次手术的时间为1个月-5年）伴心功能不全的患者（年龄≤60岁）,随机分为实验组、对照组（各有2例女性患者）。实验组（13例）在支架置入时经冠脉在梗死相关血管（IRA）移植ABM-MNCs,对照组（14例）在支架置入时经冠脉在IRA注入等体积生理盐水。在术前及术后3、6个月时为患者做心脏超声检查,收集实验设计的数据。心肌梗死距此次手术的平均时间：实验组（18±23）个月,对照组（19±20）个月,P〉0.05。平均年龄：实验组（50±10）岁,对照组（50±8）岁,P〉0.05。结果3、6个月时反映心脏收缩功能的指标每搏量（SV）、左室短轴缩短率（FS）、左室射血分数（LVEF）、左室收缩末期内径（LVD s）及二尖瓣环水平六个位点S峰均值在实验组明显好于对照组（P〈0.05）;反映心脏舒张功能的指标左室舒张末期内径（LVDd）在6个月及六个位点E峰均值在3、6个月时,实验组明显好于对照组（P〈0.05）。结论经冠脉ABM-MNCs移植能有效改善OMI后心脏收缩及舒张功能,抑制心脏重构的发展。

Objective To observe the curative effect on ventricular function and the security in old myocardial infarction （OMI） patients by intracoronary autologous bone marrow mononuclear cells （ ABM - MNCs） transplantation. Methods Twenty-seven patients with heart failure（≤60 years old）were recruited consecutively from July 2004 to March 2006 and all had transmural myocardial infarction（MI） 1 month -5 years before this operation ,in Which infarction related artery （IRA）were treated with stent implantation or stent implantation plus ABM - MNCs transplantation. They were divided randomly into test group and control group （ each group two females respectively）. For test group （13 cases）, ABM -MNCs were transplanted in IRA while stent was implanted; and for control group （14 cases）, only equalvolume of 0.9% normal saline was injected in IRA when stent was implanted. All patients accepted echocardiography examination by two ultrasonic experts randomly and single -blindly before the operation and at the third, sixth month after operation. Average time from MI to this operation was （18 ±23）months in test group, （19 ±20）months in control group, P 〉0. 05. Average age was （50 ± 10）years in test group, （50±8）years in control group, P 〉0.05. Results SV, FS,LVEF,LVDs,average S representing systolic function were improved significantly at the third, sixth month follow -up between two groups （ P 〈0. 05 ）, and the change degree of these parameters in test group were better than that in control group. LVDd at the third month and average E representing diastolic functionat the third, sixth month also were improved significantly between two groups（ P 〈0.05 ）, and the change degree of these parameters in test group were better. Conclusion Intracoronary ABM-MNCs transplantation can effectively improve systolic and diastolic functions of OMI heart as well as inhibit OMI heart from remodeling.