超声心动图评价自体外周血干细胞移植对心肌梗死并发心功能不全患者左室重构和心功能的影响

Assessment of left ventricular remodeling and cardiac function by echocardiography after transplantation of autologous peripheral blood stem cells in patients with myocardial infarction complicated with cardiac inadequacy

背景：血运重建虽能挽救缺血顿抑心肌及冬眠心肌，却无法促使已梗死的心肌细胞再生，己证实干细胞移植有可能取代受损坏死心肌，促进新生血管形成。目的：拟通过超声心动图进一步评价自体外周血干细胞移植对心肌梗死后并发心功能不全患者左室重构和心功能的影响。设计、时间及地点：于2005—03／2007—04在云南省第一人民医院心内科完成的病例分析。对象：心肌梗死并发心功能不全患者53例，年龄〈75岁，心肌梗死病史4～12周，左室射血分数〈50％，对治疗均知情同意。干预：常规治疗组30例，给予支架置入＋标准药物治疗；干细胞移植组23例，给予支架置入＋标准药物治疗后，经皮冠状动脉内将分离的干细胞悬液经球囊导管中心腔注入梗死相关动脉远端，每次注射5～10mL，球囊封堵3min，间隔3min。主要观察指标：随访6个月，应用超声心动图仪观察两组左室容量、室壁运动情况及心功能的变化。结果：53例患者均进入结果分析。与术前比较，术后6个月干细胞移植组各项指标均显著改善（P〈0．01），常规治疗组仅左室射血分数明显增高（P〈0．01）。术后6个月，干细胞移植组各项指标改善程度均显著优于常规治疗组（t=2．435-2．964，P〈0．01）。结论：超声心动图结果证实经皮经腔冠状动脉内自体外周血干细胞移植6个月后，心肌梗死并发左心功能不全患者左室容量及室壁运动情况得到明显改善，阻止或延续了左室重构。

BACKGROUND： Revascularization cannot regenerate the infarcted myocardial cells, although it may save the infarcted or stunned myocardium. It has been proved that stem cell transplantation may replace the injured necrotic myocardium and promote neovascularization. OBJECTIVE： To further assess the effect of autologous peripheral blood stem cells transplantation on the left ventricular remodeling and cardiac function of patients after myocardial infarction complicating cardiac inadequacy. DESIGN, TIME AND SETTING： The case analysis was carried out in the Department of Cardiology, the First People＇s Hospital of Yunan Province between March 2005 and April 2007. PARTICIPANTS： Fifty-three patients with myocardial infarction complicating cardiac inadequacy were enrolled in this study, aged less than 75 years, myocardial infarction history of 4-12 weeks, left ventricular ejection faction （LVEF） less than 50%. Informed consents to the treatment were obtained from all the patients. INTERVENTION： Both 23 patients in cell transplantation group and 30 patients in control group were treated by stent implantation and standard drug therapy. Moreover, percutaneous coronary intervention was given in cell transplantation group by injecting stem cell suspension into the distal end of infarction-related artery through Foley＇s tube, 5-10 mL each injection, balloon sealing for 3 minutes with the interval of 3 minutes. MAIN OUTCOME MEASURES： The two groups were followed up for 6 months to evaluate the volume of left ventricle, segmentation movement of ventricular wall, and cardiac function using echocardiography. RESULTS： Fifty-three patients were all involved in the result analysis. Compared with baseline parameters before operation, all the parameters of cell transplantation group were significantly improved, while only LVEF of control group was significantly improved 6 months after transplantation （P 〈 0.01）. These parameters＇ improvement in cell transplantation group was superior to those in the control group （t=2.435-2.964, P 〈 0.01）. CONCLUSION： Six months after percutaneous coronary transplantation of autologous peripheral blood stem cells, the volume of left ventricle and segmentation movement of ventricular wall are obviously improved, and left ventricular remodeling is prohibited or delay in patients with myocardial infarction complicating cardiac inadequacy.