冠状动脉内注射自体骨髓干细胞改善急性心肌梗死患者的心功能

Improvement of left ventricular function by intracoronary transplantation of autologous bone marrow stem cell in patients with acute myocardial infarction

目的 探讨自体骨髓干细胞冠状动脉内移植对急性心肌梗死患者心功能的影响.方法 因急性心肌梗死住院并行介入治疗的患者38例,按照完全随机分组的原则分为干细胞移植治疗组18例和对照组20例,干细胞移植治疗组患者在心肌梗死发生14 d后进行冠状动脉内注射自体骨髓干细胞治疗.术前1周和术后6个月时,采用99Tcm-MIBI心肌灌注显像、二维超声心动图评价患者心肌灌注、左心室射血分数.结果 干细胞移植治疗组与对照组比较,自体骨髓干细胞移植前2组间心肌灌注（2.1±0.1比2.2±0.2,P=0.76）和左心室射血分数（0.45±0.13比0.41±0.22,P=0.56）差异无统计学意义,术后6个月时干细胞移植治疗组心肌灌注明显好于对照组（1.5±0.2比2.3±0.4,P=0.04）,左心室射血分数高于对照组（0.55±0.12比0.44±0.24,P=0.03）,再梗死发生率、再次血运重建率和病死率2组间差异无统计学意义（P＞0.05）,而心力衰竭的发生率干细胞移植治疗组低于对照组（5.5%比35.0%,P=0.03）.结论 自体骨髓干细胞冠状动脉内移植可以改善急性心肌梗死患者的心功能,减少心力衰竭的发生.

Objective To investigate the effect of intracoronary transplantation of autologous bone marrow mesenchymal stem cell on left ventricular function in patients with acute myocardial infarction. Methods After successful percutaneous coronary intervention（ PCI） for acute myocardial infarction, 38 patients were randomly assigned to either a control group （ n = 20） that received optimum postinfarction medical treatment, or a bone-marrow-cell group（n = 18） that received optimum medical treatment and intracoronary transfer of autologous bone-marrow cells 14 days after PCI. Data about myocardial perfusion imaging and left ventricular ejection fraction （ LVEF） were obtained by SPECT and echocardiogram, respectively, before and at 6 months＇ follow-up. Results There was no significant difference between the two groups in myocardial perfusion imaging and left ventricular ejection fraction befor intracoronary transplantation of autologous bone marrow stem cell（2. 1 ±0. 1 vs 2. 2±0. 2, P = 0. 76 and 0. 45 ±0.13 vs 0.41 ±0.22, P = 0. 56）. After 6 months, SPECT myocardial perfusion was better in treated patients（1.5 ±0.2 vs 2.3±0.4, P=0.04） and LVEF improved significantly（0.55 ±0. 12 vs 0. 44 ±0.24, P=0.03） compared with the control. The incidence of heart failure in patients accepted inracoronary transplantation of autologous bone marrow stem cell was significantly decreased（5.5% vs 35.0% , P = 0. 03）, though there was no significant difference in re-infarcion, re-myocardial perfusion and death. Conclusion The left ventricular function can be improved and the heart failure can be decreased by intracoronary transplantation of autologous bone marrow stem cell in patients with acute myocardial infarction.