冠状动脉内自体骨髓单个核细胞移植治疗急性心肌梗死患者的长期疗效观察

Coronary delivery of autologous bone marrow cells in patients with acute myocardial infarction:protection of heart function

目的:探讨急性心肌梗死患者自体骨髓单个核细胞(BM-MNCs)经冠状动脉移植治疗对心功能的长期保护作用。方法:84例急性心肌梗死患者,急诊静脉溶栓或急诊介入治疗[经皮冠状动脉成形术(PTCA)加支架置入]后2周内行择期介入治疗。84例中50例作为细胞治疗组,抽取骨髓40ml,提取BM-MNCs,经冠状动脉注入;另34例作为对照组以同样方法注入20ml的0.9%氯化钠溶液。所有患者均于发病1～2周(平均9.5d)时(择期介入前)进行超声心动图检查和低剂量多巴酚丁胺超声心动图负荷试验,于发病6个月和1～5年时复查;并随访记录心血管事件发生率及病死率。结果:细胞治疗组患者5年临床随访心血管事件发生率及病死率均明显低于对照组,且心功能改善更加明显;6个月复查时,2组患者左室射血分数(LVEF)和室壁运动记分指数(WMSI)、左室舒张末容积指数(EDVI)、左室收缩末容积指数(ESVI)、心排血指数(CI)、每搏量指数(SI)等心功能指标均较术前有明显改善(P<0.01),但细胞治疗组WMSI、LVEF、ESVI、CI等指标及负荷状态下WMSI(△WMSI)、LVEF(△LVEF)均较对照组改善得更明显(P<0.01);5年超声心动图复查时,细胞治疗组EDVI、CI及LVEF较术前明显改善(P<0.01),并明显优于对照组(P<0.01)。结论:自体BM-MNCs治疗对梗死后心功能有长期保护作用。

Objective：This study is to assess beneficial effect of intracoronary transplantation of autologous bone marrow cells in patients with acute myocardial infarction （AMI）.Method：Fifty AMI patients were randomly selected into bone marrow derived mononuclear cells treatment group and 34 AMI patients in control group.All patients received emergency thromblysis and had patency of TIMI Ⅲ.Ten-fourteen 10-14 days after infarction,patients received PTCA＋stenting for coronary stenosis.Dobutamin stress echocardiography were was performed 1 day before and 6 month and 1-2 year after treatment.Forty 40 ml aspirates of born marrow were obtained in patients of cells treatment group.Mononuclear cells including endothelial progenitor cells were purified and counted,then transferred into infracted artery via 6F coronary angiography catheter.At present,all patients were in follow up study.Result：Clinical follow up shows no clear side effect in 50 patients who received autologous bone marrow cells,less nitroglycerin use and increased excise activity have been found in this group.Stress echocardiography shows significant improved left ventricular WMSI in treatment group patients,the difference between peak WMSI and basement WMSI before and 6-month after cell treatment shows was significant difference.Conclusion：Intracoronary autologous bone marrow cell transplantation is feasible and safe in AMI patients.Stress echocardiography and PET shows that autologous bone marrow cells transplantation have protection role in maintaining heart function after AMI.