冠状动脉旁路移植同期桥血管内移植骨髓单个核细胞的可行性

Feasibility of transplanting bone marrow mononuclear cells into bypass graft to improve therapeutic efficiency for coronary artery patients

背景:目前细胞移植治疗缺血性心脏病的大部分临床试验是针对急性心肌梗死患者梗死相关冠状动脉再通后骨髓单个核细胞的移植,结合外科手术同期予以细胞移植治疗陈旧性心肌梗死的报道相对较少。目的:探讨冠状动脉旁路移植术中骨髓单个核细胞经桥血管进行移植的可行性及安全性。设计:自身前后对照,病例分析。对象:2004-11/2005-06阜外心血管病医院收治的冠状动脉旁路移植手术患者10例,既往有陈旧性心肌梗死,需要进行冠状动脉旁路移植,术前左心室射血分数低于40%。方法:患者进行手术的同时,抽取自体骨髓血,采用Ficoll密度梯度离心法分离骨髓单个核细胞。在桥血管远端吻合口完成后,将骨髓单个核细胞悬液10mL注射到前降支,其他桥血管经近心端将骨髓单个核细胞悬液10mL分别注射到回旋支和右冠状动脉内。主要观察指标:术后通过心脏超声、磁共振评价心功能。结果:10例患者术后均恢复顺利,术中采集骨髓血45～60mL,分离骨髓单个核细胞数量平均为4.1×107个,锥虫蓝排斥试验测定细胞活性>95%。心脏超声检查结果显示,与术前比较,术后1周及1,3个月患者左心室射血分数明显提高;术后心肌酶、肌钙蛋白T未见异常增高,心电图未发现围手术期心肌梗死改变。磁共振扫描结果显示,与术前比较,术后3个月左心室射血分数明显增加(P<0.01);左室舒张末期直径、左室收缩末期直径均明显缩小(P<0.05)。手术过程中及术后均未见与骨髓血采集以及细胞经冠状动脉桥血管内移植的相关并发症发生。结论:作为一种辅助性治疗手段,骨髓单个核细胞通过桥血管进行心肌内移植是安全可行的。

BACKGROUND：Currently,most of the clinical trials of cell transplantation for ischemic heart disease is the transplantation of bone marrow mononuclear cells through the bypass graft artery in patients with acute myocardial infarction,but reports in combination with cell transplantation for old myocardial infarction are few.OBJECTIVE：To investigate the safety and feasibility of intracoronary artery injection of bone marrow mononuclear cells through the bypass graft artery during coronary artery bypass grafting （CABG）.DESIGN：Self-control and case analysis.PARTICIPANTS：A total of 10 patients who had old myocardial infarction,left ventricular ejection fraction （LVEF）≤40%,were selected from Cardiovascular Institute and Fuwai Hospital from November 2004 to June 2005.METHODS：The bone marrow mononuclear cells were harvested from the bone marrow by Ficoll density gradient centrifugation method before the CABG was carried.And the patients received CABG and 10 mL mononuclear cell suspension through the grafts into anterior descending branch.In addition,10 mL mononuclear cell suspension was injected into the circumflex branch and right coronary artery through the proximal heart.MAIN OUTCOME MEASURES：The heart function was evaluated with transthoracic echocardiography （TEE） and cardiac MRI after the operation.RESULTS：All patients recovered.A total of 45-60 mL bone marrow was harvested from iliac crest,and 4.1×107 mononuclear cells were isolated and identified by trypan blue test （cell activity〉95%）.TEE showed that the LVEF at 1 week and 1,3 months postoperatively was significantly improved compared with before operation;creatase and troponin T were not increased,and no myocardial infarction changes were found.MRI showed that the LVEF was significantly increased following operation （P〈0.01）;left ventricular end-diastolic and systolic diameters were significantly decreased （P〈0.05）.There was no complication associating with bone marrow harvest,or cell transplantation.CONCLUSION：Bone marrow mononuclear cells transplantation through bypass graft,as an adjunctive therapy,is safe and feasible.