冠状动脉内移植自体骨髓单个核细胞和内皮祖细胞对小型猪心肌缺血再灌注损伤的疗效比较

Effects of intracoronary transplantation of autologous bone marrow mononuclear cells or endothelial progenitor cells in mini-swine model of myocardial ischemia-reperfusion

目的比较自体骨髓单个核细胞（BM—MNC）和内皮祖细胞（EPC）移植对小型猪心肌缺血再灌注损伤后修复梗死心肌和改善心功能的疗效。方法23头小型猪心肌缺血再灌注损伤模型分为BM—MNC组[（3．54±0．90）×10^8个细膨头，n=9]、EPC组[（1．16±1．07）×10^7个细胞／头，n=7]以及对照组（n=7），比较细胞移植前以及移植4周时超声心动图、血液动力学和心肌梗死范围的变化。结果与移植前比较，移植4周时BM-MNC组、EPC组左室射血分数（LVEF）分别降低2％[（68±10）％比（66±7）％，P〉0．05]和0[（69±7）％比（69±8）％，P〉0．05]，对照组则降低10％[（70±9）％比（59±7）％，P〈0．05]，三组间比较差异有统计学意义（P〈0．05）。LVEF、左室收缩末压（LVESP）、心输出量（CO）和左室等容收缩压力最大上升速率（＋dp／dtmax）的变化值在BM—MNC组和EPC组间的差异无统计学意义（P〉0．05），而显著小于对照组的变化值（P〈0．05）。舒张末压（LVEDP）和等容舒张压力最大下降速率（-dp／dtmax）在细胞移植前后各组变化不明显（P〉0．05）。EPC和BM—MNC移植的心肌梗死面积均小于对照组[心肌梗死面积百分比分别为[（4．1±0．6）％、（8．4±3．8）％和（11．4±3．2）％，均P〈0．05]，EPC组较BM-MNC组有减小的趋势，但差异无统计学意义（P=0．067）。结论心肌缺血再灌注损伤后，自体BM—MNC和EPC移植均可明显改善左室收缩功能，这种作用可能通过减小心肌梗死面积实现。移植EPC与BM-MNC改善心功能的疗效相当，但还需进一步评价。

Objective To compare the effects of intracoronary transplantation of autologous bone marrow mononuclear cells （BM-MNC） or peripheral endothelial progenitor cells （EPC） in mini-swine model of myocardial ischemia-reperfusion. Methods The Mini-swine acute myocardial infarction and reperfusion model was created with 90 min occlusion of the left anterior descending coronary artery followed by reperfusion and the animals were then divided into BM-MNC group （3.54×10^8 ± 0.90×10^8, n =9）, EPC group （1.16 ×10^7 ± 1.07 × 10^7, n =7） and control group （saline, n = 7）. Echocardiography, hemodynamic measurements and myocardium infarction size were evaluated before and 4 weeks after intracoronary cell transplantations. Results The net decrease from baseline to 4 weeks after transplantation of left ventricular ejection fraction （LVEF）, left ventricular end systolic pressure, cardiac output and ＋ dp/dtmax were significantly attenuated post BM-MNC and EPC therapy compared to control group （ all P 〈 0, 05） and were similar between BM-MNC and EPC groups. Transplantation of BM-MNC and EPC also significantly decreased myocardial infarction size compared to control group. Conclusion Autologous intracoronary transplantation of BM-MNC or EPC in this model equally improved cardiac systolic function and reduced infarction area.