脐血及血浆输注治疗肝炎:分组对照1年随访

Umbilical cord blood and blood plasma infusion for treating hepatitis:Grouping control and 1-year follow-up

背景:研究资料证明脐血干细胞移植能改善患者肝功能和免疫功能,修复肝损伤,促进肝细胞再生,但具体分化机制及生物学特性尚不明了,远期治疗前景有待分析。目的:对照分析脐血输注与血浆输注对慢性乙型重型肝炎患者的远期治疗效果。方法:2003-01/2004-01中南大学湘雅二医院住院的慢性重型肝炎患者50例,随机分为治疗组、对照组,25例/组,两组患者均接受护肝、对症、支持等综合治疗,在年龄、病情、用药等方面无明显差异,具有可比性。脐血来源于产前检查HBsAg、抗HCV、抗HIV、KT阴性,无血液病的健康足月顺产产妇,应用一次性采血袋,以封闭式采血法采血。脐血离心后,保留有核细胞及脐血浆,24h内使用。治疗组输注脐血干细胞悬液,200mL/次,每周一两次,每例患者输注4～8次,平均5次;对照组输注成人新鲜血浆。检测两组患者治疗前后血象和肝功能各项指标的变化。结果与结论:两组患者全部完成1年随访。治疗前两组患者肝功能和血象各项指标均基本相似(P>0.05)。脐血治疗1年后,两组患者血象各项指标无明显差异(P>0.05),但治疗组谷丙转氨酶、总胆红素明显低于对照组(P<0.05),血清白蛋白明显高于对照组(P<0.05)。与治疗前比较,脐血治疗1年后治疗组血小板无明显变化,谷丙转氨酶、总胆红素均明显下降(P<0.05),血清白蛋白明显升高(P<0.05);对照组血小板明显下降(P<0.05),血清白蛋白明显下降(P<0.05)。提示脐血输注可改善重型肝炎患者的肝功能和血象,可作为其辅助治疗措施。

BACKGROUND： Umbilical cord blood transplantation can ameliorate hepatic and immunologic function, repair hepatic injury, and promote hepatic regeneration, however, the differentiation mechanism and biological characteristics remain poorly understood, and the long-term efficiency need to be explored. OBJECTIVE： To investigate the long-term therapeutic efficacy of infusing umbilical cord blood and blood plasma in treating chronic severe hepatitis B patients. METHODS： Totally 50 chronic severe hepatitis B patients received treatment at the Second Xiangya Hospital, Central South University from January 2003 to January 2004 were randomly divided into the treatment and control groups, with 25 cases in each group. All patient were accepted an ordinary synthetic treatment, and the differences between age, pathogenetic condition, medication had no significance. The umbilical cord blood was obtained from healthy full-term spontaneous delivery parturient, centrifugated, remained karyotes and cord plasma, and used within 24 hours. Patients in the treatment group were received umbilical cord blood infusion, 200 mL once, 1-2 times per week, totally, each patients infused 4-8 times （mean 5 times）; those in the control group were infused with adult fresh blood plasma. The changes of hemogram and hepatic function were measured. RESULTS AND CONCLUSION： All the patients were followed-up for 1 year. The hemogram and hepatic function indexes were similar in the 2 groups before treatment （P 0.05）. The hemogram index had no obviously difference at 1 year after treatment （P 0.05）, but the alanine aminotransferase and total bilirubin levels were decreased in the treatment compared with the control group （P 0.05）, but the albumin was significantly increased （P 0.05）. Compared with before treatment, the platelet level had no significant changes at 1 year after treatment, but the alanine aminotransferase and total bilirubin levels were deeply decreased （P 0.05）, albumin was significantly increased （P 0.05）; the platelet and albumin levels were dramatically decreased in the control group （P 0.05）. It suggested that umbilical cord blood infusion can improve the hepatic function and hemogram; therefore, it can be served as supplementary therapeutic measure for severe hepatitis.