经冠状动脉骨髓单个核细胞移植治疗原发性扩张型心肌病的远期疗效

Long term outcomes of autologous bone marrow mononuclear cells transplantation on patients with idiopathic dilated cardiomyopathy

目的研究经冠状动脉骨髓单个核细胞移植治疗原发性扩张型心肌病的远期疗效。方法入选18例原发性扩张型心肌病患者,随机分为对照组8例和移植组10例,两组均给予常规抗心力衰竭药物治疗。移植组接受经冠状动脉自体骨髓单个核细胞移植。两组术前、术后12个月分别检测血常规及生化指标(肝功能、肾功能、血糖、血脂、高敏C反应蛋白),术前、术后12个月分别行超声心动图、心电图、6min步行试验,术前和术后12个月行心脏核磁共振(MRI)检查测定左室射血分数(LVEF)。随访至两年,记录患者年住院天数,以死亡作为研究终点。结果术后12个月细胞移植组6min步行路程较术前有明显增加(521.7±78.2m比321.5±63.7m,P<0.05),LVEF变化值在细胞移植组与对照组间存在统计学差异(3.1%±4.5%比-2.4%±4.6%,P=0.019),但LVEF值较术前无统计学差异,左室舒张末内径(LVEDd)在移植组及对照组间存在明显差异(67.2±1.0mm比69.5±1.1mm,P<0.01)。研究过程中未发现有发热、过敏反应、栓塞事件等发生。结论骨髓单个核细胞移植治疗原发性扩张型心肌病安全可行,可延长6min步行路程,减小LVEDd。

Objective To identify long-term outcomes of intracoronary transplantation of autologous bone marrow mononuclear cells （ BMCs ） in idiopathic dilated cardiomyopathy （ IDC ） patients in addition to standard therapy. Methods Additional to standard drug therapy, eighteen patients with idiopathic dilated cardiomyopathy were enrolled and divided randomly into the transplantation group （ n = 10） and the control group （n = 8 ）. The baseline clinical characteristics of the two groups were comparable. Patients in the transplantation group received percutaneous coronary autologous BMCs transplantation. Blood routine test, hepatic function, renal function, glucose, triglyeride （TG）, cholesterol, low density cholesterol （LDL-C）, high density cholesterol （HDL-C） , uric acid （UA）, and high sensitive C-reactive protein （hsCRP）were measured before and at 12 months after transplantation. All patients also received ultrasonic echocardiography, Holter, six-minute-walk test and magnetic resonance imaging before and at 12 months after the procedure. The study end-point is death from any cause and the duration of hospital stay per annumn was recorded. Results The distance of six-minute-walk in the transplantation group increased after 12 months compared with the pre-transplantation level （521.7 ± 78.2 m vs 321.5 ± 63.7 m, P 〈 0. 05 ）. Changes in LVEF after transplantation of the transplantation group showed statistical difference compared with that of control group （3.1% ±4.5% vs -2.4% ±4.6%, P=0.019）, but there was no statistical difference in the absolute value of LVEF between the 2 groups （ P 〉 0. 05 ）. Statistical difference was also found in left ventricular end diastolic diameeter （ LVEDd ） between the post-transplantation group and the control （67.2 ± 1.0 mm vs 69.5 ± 1.1 ram, P 〈0.01 ）. No malignent arrhythmias and major adverse effects were recorded throughout the follow up. Conclusion Autologous bone marrow mononuclear cells transplantation can prolong the distance of six-minute-walk, decrease the LVEDd and is safe for idiopathic dilated cardiomyopathy patients.