骨髓干细胞移植治疗心肌梗死的临床疗效

Clinical effect of bone marrow stem cell therapy in patients with myocardial infarction treated by PCI

目的了解心肌梗死（MI）患者行冠状动脉内支架置入术（percutaneous coronary intervention，PCI）后进行骨髓干细胞移植治疗的临床疗效。方法研究对象为2003年5月～2005年12月住院的MI患者246例，其中PCI后进行骨髓干细胞移植治疗者48（男44，女4）例，年龄29～74（58±9）岁。随机选择年龄相匹配，PCI后未经骨髓干细胞移植治疗的MI者198（男178，女20）例，年龄25—70（58±9）岁。采用Judkins方法经股动脉行冠状动脉造影和左室造影。全部病例均经心脏超声检查及随访，其中96例经冠状动脉造影随访（随访率39％），随访时间1—30（9．6±6）个月。造影证实原支架内血管直径狭窄≥50％，定为支架内再狭窄。48例PCI后进行骨髓干细胞移植治疗者在冠状动脉造影术前2h，局麻下选择髂后上棘穿刺抽取骨髓液40-80ml，分离骨髓单个核细胞备用。所有患者入院后详细记录病史，体格检查，于次日晨空腹取肘静脉血检查血脂（标准酶法）、血浆纤维蛋白原（凝血酶法）水平和肝、肾功能等。结果PCI后进行骨髓干细胞移植治疗组与单纯PCI治疗组相比：年龄、性别、吸烟、高血压病、糖尿病、血脂和纤维蛋白原水平，以及冠脉血管病变支数均无显著差异；PCI后进行骨髓干细胞移植治疗组支架再狭窄发生率低（P〈0．01）；两组治疗前后射血分数值改善情况均有显著统计学差异（P〈0．01）。结论PCI后进行骨髓干细胞移植治疗MI可以降低支架再狭窄率，改善心功能。

AIM To observe the therapeutic effects of bone marrow stem cell transplantation for patients undergoing percutaneous coronary intervention （PCI） after myocardial infarction. METHODS Enrolled in the study were 246 patients with PCI after myocardial infarction in our hospital from May, 2003 to Des, 2005. The patients were divided into two groups： 48 patients [ 44 men and 4 women, mean age （58 ± 9） years] with bone marrow stem cell transplantation after PCI and 198 patients [ 178 men and 20 women, mean age （58 ± 9） years and left ventriculography. During patients underwent uhracardiograp ] with no transplantation. Judkins was used for coronary arteriongraphy the follow-up from 1 to 30 months （ mean time 9.6 ± 6 month）, all the hy and 96 of them had coronary arteriongraphy. In-stent restenosis was defined by angiography. Bone marrow was reserved 2 hours before PCI for patients treated with transplatation. All the patients had their medical history recorded and physical examinations and their fast levels of fat, plasma fibrinogen, hepatic and renal function were detected from ular venous blood. SPSS11.0 software was used in all statistical analyses. RESULTS No significant differences were observed between the two group in mean age, distribution of gender, smoking, hypertension and diabetes, levels of blood fat and fibrinogen, and the number of diseased coronary arteries. However, compared with the group without transplantation, the group with transplantation had lower in-stent restenosis rate （ P 〈 0. 01 ） and better improvement of LVEF （ P 〈 0. 01 ）. CONCLUSION Bone marrow stem cell transplantation reduces the restenosis rate and improves the cardiac functions in patients undergoing percutaneous coronary intervention after myocardial infarction.