干细胞在心血管疾病治疗中的应用

Application of stem cells in treatment of cardiovascular disease

学术背景:冠状动脉粥样硬化性心脏病(简称冠心病)、心肌梗死、原发性高血压、心肌病、心瓣膜病等心血管疾病的共同特点是有完整舒缩功能的心肌细胞数量相对和绝对减少,患者对于常规的药物治疗反应性极差,而干细胞移植作为一种新的治疗方法,极具发展潜力。目的:探讨干细胞分化为心肌细胞的潜能并介绍其在心血管疾病治疗方面的应用。检索策略:由作者应用计算机检索Pubmed数据库1999-01/2007-08与干细胞和高血压病/冠心病有关的文章,检索词"bone marrow stromal cells,coronary artery disease,cardiovascular disease"组合检索,并限定语言种类为"English";同时检索中国期刊全文数据库2000-01/2007-05相关文章,检索词为"干细胞,心血管疾病,移植",并限定语言种类为中文。纳入内容与干细胞在心血管疾病治疗中的应用相关文章,内容相似者以近5年且发表在较权威杂志者优先。文献评价:共收集到300篇相关文献,阅读标题和摘要进行初筛,排除251篇内容陈旧或重复的文献,保留49篇进一步查找全文,有48篇检索到全文,选用其中34篇进行综述。5篇涉及骨髓间充质干细胞在高血压治疗中的应用,20篇为骨髓干细胞在冠心病治疗中的应用相关研究,9篇骨髓干细胞的诱导分化及其在心血管疾病治疗中的研究现状。资料综合:胚胎干细胞、成体干细胞(包括骨骼肌祖细胞、骨髓干细胞、心脏干细胞)都能用于移植治疗心血管疾病。目前干细胞移植在冠心病治疗方面已取得了可喜的成果,在高血压的治疗方面还在实验阶段,且研究较少。而且干细胞移植治疗冠心病,多为近期疗效观察,远期预后如何,尚待研究。结论:干细胞治疗心血管疾病正处在起步阶段,在治疗急性心肌梗死方面已表现出传统治疗方法无可比拟的优越性,干细胞可以在梗死的心肌中分化形成有功能活性的心肌、血管、内皮等组织,可以改善心脏的功能。

BACKGROUND： Cardiovascular diseases, such as coronary heart disease, myocardial infarction, essential hypertension, myocardiopathy and valvular disease, are characteristic as the relative and complete reduction of myocardial cells, which have the diastolic and contractile function, and those patients all are extremely ineffective by the routine therapy. Stem cell transplantation is regarded as one of potential treatment. OBJECTIVE： To explore the potentiality of stem cell differentiating into myocardial cells and introduce the application of stem cells in the treatment of cardiovascular disease. RETRIEVE STRATEGY： A computer-based online search of Pubmend database was undertaken to identify the articles about the stem cells and hypertension/coronary heart disease published from January 1999 to August 2007 in English, with the key words ＂bone marrow stromal cells, coronary artery disease, cardiovascular disease＂; Meanwhile, the related Chinese articles were retrieved in the Chinese Journal Full-text Database between January 2000 and May 2007, with the key words ＂stem cells, cardiovascular disease, transplantation＂ in Chinese. Inclusive cnterion was the articles referring to the stem cells in treatment of cardiovascular disease, and those published in the authority in recent 5 years were preferred. LITERATURE EVALUATION： A total of 300 articles were collected, after the primary screening of the title and abstract, 251 ones of them were excluded due to the outdated content or repetition, while the remaining 49 ones were selected for full texts. Among the 48 literatures in full-texts, 34 were included for reviews, including 5 for the application of bone marrow mesenchymal cells in treatment of hypertensive disease, 20 for the related study on bone marrow stem cells for coronary heart disease, and 9 for the differentiation of bone marrow stem cells and their application in the treatment of cardiovascular disease. DATA SYNTHESIS： Embryonic stem cells and adult stem cells （skeletal muscle progenitor cell, bone marrow stem cell and cardiac stem cell） are all suitable for treating the cardiovascular disease. At current, the stem cell transplantation has been achieved a lot in the treatment of coronary heart disease, but only a few studies focus on the hypertensive therapy. Moreover, the curative effect by stem cell transplantation is evaluated chiefly for a short term, and no idea is known about the long-term prognosis. CONCLUSION： Stem cell therapy for cardiovascular disease is at the primary stage, and it is extremely superior to routine treatment in the curing of acute myocardial infarction. Stem cells can improve the cardiac function by differentiating into cardiac muscle, vessel and endothelial tissues.