CABG联合自体干细胞移植治疗心肌梗死疗效观察

Effect of autologous peripheral blood stem cells transplantation and CABG on myocardial infarction

目的观察冠脉搭桥术(CABG)联合经冠状动脉桥血管及心外膜下注入自体外周血干细胞治疗心肌梗死的疗效。方法 32例冠心病心肌梗死患者,随机分为对照组和观察组,各16例。观察组术前5 d使用重组人粒细胞集落刺激因子皮下注射进行外周血干细胞(PBSC)的动员及扩增。CABG术前24 h进行PBSC的采集和浓缩。两组均在非体外循环下行CABG,观察组在完成血管桥吻合后,经桥血管及心外膜下注入PBSC。术前1周及术后3、6个月采用二维超声心动图和99mTc-MIBI心肌灌注显像检测两组患者左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及心肌灌注情况。结果术后3、6个月二维超声心动图检查显示两组患者LVEF、LVEDD均较术前改善,组间比较观察组较对照组改善程度更大(P均<0.05)。术后6个月99mTc-MIBI心肌灌注显像显示两组患者充盈缺损区域均较术前缩小,观察组较对照组充盈缺损区域缩小程度更明显(P均<0.05)。结论 CABG联合自体外周血干细胞移植治疗心肌梗死安全可行,患者术后心肌灌注和心功能恢复满意。

Objective To study the effect of autologous grafts peripheral blood stem cells transplantation and preoperative coronary artery bypass grafting（CABG） on myocardial infarction.Methods 32 myocardial infarction patients were divided into observe group and control group.Before CABG,G-CSF was used to stimulate the autologous peripheral blood stem cells（PBSC） in observe group.The coronary artery circuitous transplantion surgery was carry out with non-cardiopulmonary bypass.After the completion of the anastomosis of the bridge vascular,the PBSC was injected via bridge coronary vessels and subepicardial in observe group,Two-dimensional echocardiography and 99mTc-MIBI myocardial perfusion imaging was used to evaluate LVEF,LVEDD and myocardial perfusion 1 week before and 3,6 months after the operation.Results LVEF and LVEDD improved 3 and 6 months after the operation.99mTc-MIBI myocardial perfusion imaging improved 6 months after the operation.The improment level in observe group was more significantly than that in control group.Conclusion Autologous peripheral blood stem cell transplantation in CABG for the treatment of coronary heart disease is feasible and safe.It can significantly improve cardiac function and myocardial perfusion.