自体骨髓间充质干细胞移植治疗心肌梗死后心力衰竭的实验及临床研究

The experimental and clinical study on bone marrow-derived mesenchymal stem cells transplantation to post-infarcted failure heart

目的观察自体骨髓间充质干细胞(MSCs)移植对心肌梗死后心力衰竭的疗效。方法选择21只中国小型家猪,应用闭胸经股动脉介入法制作心肌梗死后心力衰竭模型,术后动物左室射血分数(LVEF)<45%、B型钠脲肽(BNP)水平>100 pg.ml-1为心力衰竭建模成功。随机将动物分为实验组(n=11)和对照组(n=10),术后2周内实验组及对照组经冠状动脉途径分别移植MSCs及磷酸盐缓冲液,8周后,行心脏彩超、单光子发射型计算机断层扫描(ECT)及BNP检查,观察心功能的改变。同时,选择心肌梗死致心力衰竭[左室射血分数(LVEF)<45%,BNP>100 pg.ml-1]患者8例,发病2周内经皮冠状动脉途径植入MSCs,术前及术后8周行心脏彩超、ECT及BNP检查,监测心功能的变化。结果动物实验组和对照组分别有8头和7头猪造模成功;心脏彩超结果显示:实验组MSCs移植后LVEF由(39±1.70)%增加至(51±3.52)%,ECT心血池显像显示LVEF由(35.08±3.12)%升高至(52.15±1.21)%,BNP水平由移植前的(298±17)pg.ml-1下降至(87±15)pg.ml-1;对照组以上指标无明显改变。临床观察显示:MSCs移植后患者心脏彩超显示LVEF由(34.06±2.13)%增加至(52.08±1.02)%,ECT心血池显像显示LVEF由(34.12±3.09)%增加至(53.03±1.01)%,BNP水平由(326±34)pg.ml-1降低至(101±7)pg.ml-1。结论自体MSCs移植是治疗急性心肌梗死后心力衰竭安全、有效的新方法。

Objective To observe the effects of directed transplantation of allogeneic bone marrow-derived mesenchymal stem cells（MSCs） on post-infarcted failure heart. Methods Twenty-one healthy male swine underwent closed-chest to establish acute myocardial infarction models of heart failure with LVEF 〈 45% and BNP level 〉 100 pg· ml ^- 1, then they were divided into two groups randomly ： experimental group with MSCs transplantation （n = 11 ）, control group with PBS injection （ n = 10）. Eight patients who suffered from acute myocardial infarction with heart failure treated with MSCs in two weeks. Eight weeks after MSCs transplantation, transthoracic echocardiography, single-photon em ission computed tom ography（ECT） and BNP were performed to observe the change of cardiac function. Results Experimental group LVEF increased with the transthoracic echocardiography,ECT（39 ± 1.70）% vs（51 ±3.52）%, （35.08 ±3.12）% vs（52.15 ± 1.21 ）% respectively, and BNP declined （298 ± 17） pg· ml -^1 vs （ 87 ± 15 ） pg· ml ^- 1. In the patients, transplantation of bone-marrow ceils enhanced left-ventricular systolic function （ 34.06 ± 2.13 ） % vs （ 52.08 ± 1.02 ） % ; ECT （ 34. 12 ± 3.09）% vs（53.03 ±1.01）% ,BNP declined（326 ±34）pg·ml^-1 vs （101 ±7）pg·ml^-1. Conclusion Transplantation of allogeneic bone marrow-derived mesenchymal stem cell can effectively treat heart failure in animals and patients.