自体卫星细胞移植治疗心肌梗死的临床研究

Clinical research of myocardium infarction therapy by transplanting satellite cells

目的移植自体卫星细胞（SC）修复受损心肌，治疗心肌梗死。方法冠心病并发心梗患者10例，男女各半。术前2周切取股四头肌肌组织2cm×2cm×2cm一块，采用改良Dorfman法体外培养SC，在冠脉搭桥术（CABG）的同时，梗死区注射植入SC。术前、术后3个月分别进行心电图、心脏彩超、99m^Tc单电子发射计算机断层扫描（SPECT）心血池显像、^18 F—FDG心肌灌注显像检查。观察梗死区的细胞代谢情况，测量左室射血分数。结果（1）SC贴壁生长，延迟分瓶或降低培养液中胎牛血清（FBS）浓度，SC生长停滞，相互融合形成肌管；（2）10例患者平均搭桥2.7支，其中一例仅进行了SC移植手术，无住院死亡，3个月后心功能均恢复至Ⅰ级，心绞痛症状消失。（3）术后3个月复查心肌灌注显像显示原细胞代谢缺失区重新出现细胞代谢活动（包括未行CABG手术者），心血池显像提示LVEF增加（9．70±4．17）％，与术前比较差异有统计学意义（P〈0．01）。结论自体SC移植于心肌梗死区后能存活，可能通过参与心脏收缩、舒张活动，软化瘢痕，改善心肌顺应性，促进梗死区血管再生等途径改善心功能。

Objective Satellite cells （SCs） transplant was tried to treat myocardium infarction （MI） in human. Methods 10 patients who affected by coronary artery disease （CAD） and MI were selected. A piece of muscle was taken away from their quadriceps femoris 2 weeks before surgical operation. SCs were extracted, purified, cultured by modified Dorfman method, and then transplanted into the MI area by intramyocardial injection after CABG. EKG, UCG, ^99m Tc-SPECT cardiac blood pool imaging, 18F-FDG myocardial perfusion imaging were examined before operation and 3 months after operation. The cell metabolism status in the MI area were observed and LVEF were measured and analyzed by paired-samples t test with SPSS13.0 statistics software. Results After cultured in vitro for3 days, SCs were spindleshaped, and sticked to walls. SCs growth was stasis, fused into each other, and formed myotube when the cells were delayed to divide Petri dish or the concentration of fetus bovine serum （FBS） in the culture medium was reduced. Average 2. 7 blood vessel bypass were established in these patients. SCs were transplanted merely in one patient whose coronary arteries were extensively sclerosed. No patients died in hospital. Heart function of these patients were recovered to NYHA Ⅰ 3 months after operation. Their symptoms of angina pectoris were disappeared and quality of life was improved obviously. The cell metabolism activity was appeared again in the MI area 3 months after operation （including the patient without CABG）. LVEF were increased （9. 70 ± 4. 17 ）% than preoperation. There is significant deviation between them （ P 〈 0. 01 ）. Conclusions Autograft of SCs can be alive in the MI area, and SCs can improve the heart function by participating the heart＇s systole and diastole activity directly or by altering cardiac compliance and stimulating the blood capillary proliferation.