非体外循环冠状动脉旁路移植术后骨髓干细胞动员的临床研究

Clinical experiments on marrow stem cell mobilization after off-pump coronary artery bypass graft

目的研究非体外循环冠状动脉旁路移植术后骨髓于细胞动员规律及影响因素。方法75例择期冠脉搭桥、近期无急性心肌梗死患者，分别于术前30min、术后6、12、24、48、72、120h采外周静脉血4ml，行CD34和CD45双抗标记、流式细胞仪检测骨髓干细胞计数，同时检测心肌酶谱及肌钙蛋白T变化。结果冠心病患者术前外周血中存在少量的骨髓干细胞，占有核细胞数的（1．32±1．16）‰，非体外循环冠脉搭桥术后24h达到峰值，为（3．41±2．00）‰，72～120h回到术前基线水平；高血脂、糖尿病对骨髓干细胞动员无明显影响，但合并高血压患者外周血骨髓干细胞动员明显低于非高血压患者；术后24h肌酸激酶及其同工酶MB、乳酸脱氢酶、肌钙蛋白T与CD34^＋细胞动员存在正相关。结论冠脉搭桥术后骨髓干细胞快速、短暂动员，心肌损伤程度与冠心病危险因素参与了骨髓于细胞动员的调节。

Objective To study the regularities and the influencing factors of marrow stem cell mobilization after off- pump coronary artery bypass graft（CABG） .Methods Seventy- five patiouts with coronary artery disease without acute myocardial infarction who needed selective CABG were included in this study.4 ml of blood samples were taken at 30 min pre- operation,6 h, 12 h,24 h,48 h,72 h, and 120 h post - operation. The marrow stem cell counts were made by flow cytometer with CD34 and CD45 double antibody. The serum myocardium enzyme and troponin T were measttred at the same time. Results There were a few marrow stem cells accounting for （ 1.32 ± 1.16）%o of all nucleated cells in the peripheral blood circulation in patients with coronary artery diseases before operation. The marrow stem cell counts signifieantly increased, peaking at 24 hours after off- pump CABG, accounting for （341 ± 2.00）%o of all nucleated cells and returning to pre - operation level at 72 - 120 hours after operation in the peripheral blood circulation. Hyperlipidemia and diabetes meUitus had little effect on marrow stem cell mobilization, which was obviously reduced by hypertension. The marrow stem cells counts were positively correlated with CK, CK - MB,LDH,troponin T （ r = 0.70, P = 0.00, r = 0.66,P = 0.00, r = 0.48,P = 0.00, r = 0.75,P = 0.00,respectively）.Condusions The marrow stem cells mobilize rapidly and temporarily after off- pump CABG. The extent of myocardial injury and coronary artery risk factors take part in marrow stem cell mobilization.