自体骨髓干细胞移植治疗急性心肌梗死27例近期疗效(英文)

Autologous bone marrow stem cell transplantation for acute myocardial infarction in 27 cases:Short-term curative effects

背景：有实验表明移植心肌梗死区的骨髓干细胞可以定向分化为具有正常生理功能的心肌细胞并可促进新生血管形成，达到修复梗死心肌并改善受损的心脏功能。目的：观察经皮冠状动脉内移植自体骨髓干细胞治疗急性心肌梗死的近期临床疗效。设计：自身前后对照。单位：湘潭市中心医院心内科。对象：选择2004—06／2006—12在湘潭市中心医院心内科收治的27例急性心肌梗死患者，男16例，女11例，年龄34-74岁，平均（61±9）岁；纳入标准：①入选发病超过6h。②心电图、酶学动态的改变符合急性心肌梗死。③心功能在Ⅰ-Ⅱ级之间。（多发病后急诊完成经皮冠状动脉介入治疗且梗死相关血管血流恢复至TIMI级。所有患者均签署了知情同意书。方法：手术过程：所有患者均于发病后行急诊冠状动脉介入治疗，1周后经皮腔导管技术建立梗死相关动脉通道，用指引导丝将微灌注导管送入支架内后，将分离的骨髓干细胞悬液经微导管中心腔内注入梗死血管远端。术后评价：移植前、后分别行24h动态心电图评估；移植前和移植后6，12个月检测患者左室射血分数、心肌灌注缺损指数。术后6，12个月随访观察恢复及并发症情况。主要观察指标：①左室射血分数、心肌灌注缺损指数。②24h动态心电图评估结果。③术后并发症情况。结果：纳入患者27例均进入结果分析。①左室射血分数、心肌灌注缺损指数：术后6，12个月左室射血分数均高于移植前，差异有统计学意义（P〈0．05），心肌灌注缺损指数均低于移植前，差异有统计学意义（P〈0．05）。②动态心电图结果：患者均无新的-12,律失常类型出现，无心律失常的增多及恶性心律失常的出现。㈣随访评估：经冠状动脉内移植术中无并发症发生，无患者支架内狭窄。结论：经皮冠状动脉内移植骨髓干细胞治疗急性心肌梗死安全可行，术后能改善心功能。

BACKGROUND： Recent researches demonstrate that transplantation of bone marrow stem cells in the area of myocardial infarction can directionally differentiate into myocardial cells having normal physiological function and can promote newborn vascularization so as to repair infarction myocardium and improve injured cardiac function. OBJECTIVE： To observe short-term clinical effect of autologous bone marrow stem cell transplantation （ABMSCT） in percutaneous coronary artery on the treatment of acute myocardial infarction. DESIGN ： Self-control study SETTING： Department of Cardiology, Xiangtan Central Hospita PARTICIPANTS： A total of 27 patients with acute myocardial infarction, including 16 males and 11 females, were selected from Department of Cardiology, Xiangtan Central Hospital from June 2004 to December 2006. Their ages ranged from 34 to 74 years, and the mean age was （61＋9） years. Inclusion criteria： ① Onset of acute myocardial infarction lasted for over 6 hours; ② Dynamic changes of electrocardiogram and enzymology were coincident with acute myocardial infarction; ③ Cardiac function ranged from grade Ⅰ to grade Ⅱ ④Interventional therapy of percutaneous coronary artery was finished after onset emergently; in addition, blood flow of infraction related vessels recovered to grade TIMI3. All patients provided the confirmed consent. METHODS： Operative procedure： All patients were performed with emergently interventional therapy of coronary artery after onset of acute myocardial infarction. One week later, percutaneous cavity tube technique was used to establish infarction related arterial pathway, and guiding filament was used to send micro-perfusion tube into stents. And then, separated bone marrow stem cell suspension was poured through central cavity of micro-tube into the distal end of infarction vessels. Operative evaluation： Dynamic electrocardiogram was evaluated for 24 hours before and after transplantation; in addition, left ventricular ejection fraction and myocardial perfusion defect scores were detected before and at 6 and 12 months after transplantation; otherwise, recovery state and complication were observed in follow up at 6 and 12 months after operation. MAIN OUTCOME MEASURES： ① Left ventricular ejection fraction and myocardial perfusion defect scores; ②evaluating results of dynamic electrocardiogram within 24 hours; ③complication after operation. RESULTS ： All 27 patients were involved in the final analysis. ① Left ventricular ejection fraction and myocardial perfusion defect scores： At 6 and 12 months after operation, left ventricular ejection fraction was higher than that before transplantation, and there was significant difference before and after transplantation （P 〈 0.05）. While, myocardial perfusion defect scores were lower than those before transplantation, and there was significant difference before and after transplantation （P 〈 0.05）. ② Evaluating results of dynamic electrocardiogram within 24 hours： New types of cardiac arrhythmia were not found out, cardiac arrhythmia was not increased, and cardiac arrhythmia combining with malignancy was not observed.③Follow-up evaluation： Patients who received percutaneous intracoronary artery transplantation did not have any complications and in-stent constriction after operation. CONCLUSION： It is safe and reliable for autologous bone marrow stem cell transplantation in percutaneous coronary artery to treat acute myocardial infarction. Meanwhile, autologous bone marrow stem cell transplantation can improve cardiac function.