冠脉搭桥术同期自体外周血干细胞移植治疗冠心病的临床研究

Clinical Research for Treatment of Coronary Heart Disease with Peripheral Blood Stem Cells Transplantation in CABG

目的研究自体外周血干细胞（PBSCs）在冠脉搭桥手术时，同期经心外膜下及冠状动脉桥血管注入对冠心病、心肌梗死患者心功能的影响及其安全性．方法6例冠心病伴心肌梗死患者，在冠状动脉旁路移植同期经心外膜下注射及冠状动脉通过冠脉转运将PBSCs植入心肌梗死区，术前和术后2周及3个月分别行99mTcMIBI心肌灌注显像、二维超声心动图及动态心电图检查．结果6例患者二维超声心动图检查示左心室射血分数（LVEF）较术前平均增加15．6％（12．1％～20．6％），左心室舒张末期内径（LVDd）较术前平均减少5．5mm（-2～9mm），99mTcMJB[显示梗死部位心肌灌注明显改善．术中及术后随访3～6月均无恶性心律失常和其它合并症发生．结论自体PBSCs在冠状动脉旁路移植同期经心外膜下注射及经冠脉移植治疗冠心病心肌梗死，可以抑制左心室重构，改善心脏功能．

Objective To evaluate the effects and （PBSCs） in coronary artery bypassing grafting （CABG） safety of transplantation of peripheral blood stem cells for the treatment coronary heart disease. Methods Six patients who had suffered from coronary heart disease with myocardial infarction were reselected. PBSCs were transplanted immediately following CABG. Autologous PBSCs were isolated and cultured for 23 weeks. And 1.1 1.4×10^6 were transplanted through intra coronary way. Cardiac functions were determined by 99m methoxy iso butyl isonitile （99mTcMIBI）, 2D echocardiogram and ECG Holter monitor 2 weeks and three months before and after the operation respectively. Results Left ventricular ejection fraction （LVEF） was significantly increased by 15.6% （ 12. 1% - 20.6% ） and left ventricular diastolic diameter （LVDd） reduced by 5.5 mm （ - 2 9mm） through 2D echocardiogram and myocardial perfusion significantly improved in infarction site through 99mTcMIBI. Neither obvious arrhythmia nor complications were observed during the 6 - 12 months follow up in all the 6 patients. Conclusion The preliminary study showed that in the patients who suffered form coronary heart disease complicated with myocardial infarction, transplantation of PBSCs could restrain the reconstruction of left ventricle and improve cardiac function and cardiac perfusion without significant complication and arrhythmia during the 6 - 12 months follow up.