骨髓间充质干细胞移植改善心肌梗死患者心功能

Bone marrow mesenchymal stem cell transplantation in the amelioration of heart function in patients with myocardial infarction

学术背景:目前常用的心肌梗死治疗方法--介入治疗能改善心肌缺血,但坏死心肌不能自主修复。近年来干细胞移植成为治疗缺血性心脏病研究的热点,且间充质干细胞具有取材方便,免疫排斥性低,多向分化性,不涉及伦理道德问题等优点,更是倍受重视。目的:总结骨髓间充质干细胞移植治疗心肌梗死的研究进展。检索策略:由该论文的研究人员应用计算机检索Pubmed数据库1990-01/2007-12关于骨髓间充质干细胞治疗心肌梗死的文献,检索词"Mesenchymalstemcells,transplantation,myocardialinfarction",并限定文章语言种类为English。同时检索万方数据库2002-03/2007-03相关的文章,检索词为"骨髓间充质干细胞移植,心肌梗死",并限定文章语言种类为中文。然后对资料进行初审,纳入标准:①与骨髓间充质干细胞治疗心肌梗死密切相关。②同一领域选择近期发表或在权威杂志上发表的文章。排除标准:重复性研究。文献评价:文献的来源主要是骨髓间充质干细胞移植治疗心肌梗死方面的随机对照试验。所选用的31篇文献中,7篇为综述,其余均为临床或基础实验研究。资料综合:①骨髓干细胞具有比既往预期更高的可塑性,在心肌梗死后能迁移到心肌损伤部位,在心脏环境中横向分化为心肌细胞和血管内皮细胞,参与坏死心肌组织的再生。②临床研究证实,骨髓干细胞移植可以改善心肌梗死患者的心功能。③关于骨髓间充质干细胞在软骨修复方面的研究虽已取得较大进展,但仍存在许多问题,如测定移植细胞的成活率并找到提高其成活率的方法;心肌梗死面积多大进行细胞移植会更有效;需发明一种能长期标记移植细胞的技术,明确被成功移植的细胞的状态;确定最佳细胞移植的时间、数量,并进一步完善移植方法等。结论:有关骨髓间充质干细胞改善心肌梗死患者心功能、细胞移植方法等方面的研究取得很大的进展,但仍存在许多需要解决的问题。

BACKGROUND： Currently, interventional therapy can ameliorate myocardial ischemia, but necrotic myocardium cannot actively repair. Recently, stem cell transplantation has been the hot research in the treatment of ischemic heart diseases. Mesenchymal stem cells have been reconstructed with the characteristics of easy material collection, low immunologic rejection, multi-directional differentiation and no ethics problems. OBJECTIVE： To summarize the research progress of bone marrow mesenchymal stem cell transplantation for myocardial infarction. RETRIEVE STRATEGY： The Pubmed Database was undertaken to identify the relevant articles on bone marrow mesenchymal stem cell transplantation for myocardial infarction published from January 1990 to December 2007 with the key words of ＂Mesenchymal stem cells, transplantation,myocardial fnfarction＂ in English. Simultaneously, the Wanfang Database was also searched for relevant articles published from March 2002 to March 2007 with the same key words in Chinese. The data were primarily searched. Inclusive criteria included ①articles on bone marrow mesenchymal stem cell transplantation for myocardial infarction, and ②articles in the same circle published in the authoritative journals or recently published. Exclusive criteria included articles on repetitive studies. LITERATURE EVALUATION： The articles were randomized controlled trials on bone marrow mesenchymal stem cell transplantation for myocardial infarction. Of the 31 articles, 7 were review, and others were clinical or basic experimental studies. DATA SYNTHESIS： ①Bone marrow stem cells have higher plasticity, can move to the injured myocardium after myocardial infarction, differentiate into cardiomyocytes and vascular endothelial cells, and participate in the regeneration of necrotic myocardium. ②Clinical studies verified that bone marrow stem cell transplantation could improve heart functfon in patients with myocardial infarction. ③Studies on bone marrow mesenchymal stem cells in the repair of cartilage have made great progresses. But there are many problems, for example, the measurement of transplanted cell survival rate; the method of elevating survival rate; how large the fnfarcted area is to have an effective cellular transplantation; a technique that can label transplanted cells for a long term; the condition of successfully transplanted cells; the determination of optimal transplanted time and transplanted amount; improved transplanted methods, and so on. CONCLUSION： Studies on bone marrow mesenchymal stem cells improving heart function in patients with myocardial infarction, and cell transplantation methods have had great progresses, but many problems are still existed.