异基因脐血干细胞移植治疗失代偿期肝硬化的疗效观察

Efficacy of allogeneic umbilical cord blood stem cell transplantation for treatment of decompensated cirrhosis

目的观察异基因脐血干细胞移植治疗失代偿期肝硬化患者的临床疗效。方法失代偿期肝硬化患者50例,其中乙型、丙型肝炎肝硬化36例,酒精性肝硬化12例,胆汁性肝硬化2例;Child-Pugh分级:A级2例,B级32例,C级16例。所有患者治疗前均行肝功能及影像学等检查,排除肝癌,严格筛查产妇,无菌采取脐血并分离出干细胞,通过导管经肝固有动脉将干细胞混悬液植入肝脏,分别在术后2、4、12、24w复查肝功能,观察实验室指标、影像学改变、临床症状及不良反应等情况。结果干细胞移植后患者症状改善明显,Alb2周时短暂下降,由均值28.4g/L降至26.3g/L(P>0.05),24周Alb升至37.3g/L(P<0.01),ALT由56.9U/L降至46.3U/L(P<0.05),AST由75.3U/L降至50.0U/L(P<0.05),TBil由45.3μmol/L降至31.2μmol/L(P<0.05),PTA由41%升至70%(P<0.01);腹水患者36例腹水消失,5例腹水明显减少,1例腹水变化不明显;24周复查CT,肝脏最大截面积均值由132cm2增至178cm2(P<0.01),肝脏平扫CT值由52.6降至49.3(P>0.05),肝裂缩小。50例患者均未发生不良反应。结论异基因脐血干细胞移植治疗失代偿期肝硬化安全可行,可明显改善肝硬化患者的临床症状、肝功能、凝血功能和肝脏大小。

Objective To determine the therapeutic effect of allogeneic umbilical cord blood stem cell transplantation in the treatment of patients with decompensated cirrhosis.Methods Total 50 patients of decompensated liver cirrhosis were included as follows：36 cases of liver cirrhosis based on chronic hepatitis B and hepatitis C,12 cases of alcoholic liver cirrhosis,and 2 cases of biliary cirrhosis.The patients＇s Child-Pugh classification were as follows：2（grade A） and 32（grade B）,and 16（grade C）.Stem cells were transplanted into the liver through liver artery catheter.Liver function and imaging examination of all the patients were checked after 2,4,12 and 24weeks of therapy respectively,while clinical symptoms and adverse reaction were observed.Results Symptoms were improved obviously after stem cells transplantation.Alb dropped transiently at 2 weeks from the mean value of 28.4 g/L to 26.3 g/L（P 0.05）,but Alb increased to 37.3 g/L after 24 weeks（P 0.01）.The mean value of ALT,AST,TBil dropped from 56.9 U/L to 46.3 U/L（P 0.05）,75.3 U/L to 50.0 U/L（P 0.05）,45.3 μmol/L to 31.2μmol/L（P 0.05） respectively.PTA increased from 41% to 70%（P 0.01） after 24 weeks therapy.Ascites disappeared in 36 patients,lessened in 5 patients,and no change in l case.The mean value of the largest cross-sectional area of liver CT scanning increased from 132 cm2 to 178 cm2（P 0.01）,and CT value from 52.6 down to 49.3 in the unenhanced CT scanning（P 0.05）.Liver cracking narrowed.No adverse effects were observed in any of the cases.Conclusion Allogeneic umbilical cord blood stem cell transplantation in the treatment of decompensated cirrhosis is safe and feasible.The clinical symptoms and liver function and liver size of the patients were improved significantly with this therapy.