脐血干细胞移植治疗失代偿期肝硬化的临床疗效

Therapeutic effect of human umbilical cord blood stem cells transplantation in patients with decompensated cirrhosis

目的:探讨人脐血干细胞(umbilical cord blood stem cell,UCBSC)外周静脉移植治疗失代偿期肝硬化的临床疗效及可行性。方法:20例失代偿期肝硬化患者采用人UCBSC外周静脉移植治疗,治疗后定期观察患者血清转氨酶(ALT、AST)、总胆红素(TBIL)、白蛋白(ALB)、凝血酶原时间(PT)和纤维蛋白原(FIB)水平变化,并观察患者临床症状及体征的改善情况及不良反应。结果:UCBSC移植治疗后2周,各项肝功能指标较治疗前无显著性差异(P>0.05);治疗后4周,除ALT和AST有所改善外(P<0.05),其余指标无明显改善;治疗后8周各项肝功能指标均有改善(P<0.05),12周有显著性改善(P<0.01)。治疗后4周大多数患者的临床症状有明显改善,腹水减少和双下肢浮肿减轻15例(75.0%)、乏力好转16例(80%)、食欲改善13例(65%)。UCBSC移植后12周患者总体生存率为90%,其中2例患者分别在UCBSC静脉移植后4周和8周因为肝性昏迷和自发性细菌性腹膜炎而死亡。所有患者均未发现与细胞移植相关的副作用。结论:UCBSC外周静脉移植是治疗失代偿期肝硬化一种安全有效的方法,短期内可以改善失代偿期肝硬化患者肝功能及临床症状,是一种值得推荐的治疗方法。

Objective：To investigate the clinical effect and feasibility of human UCBSC（umbilical cord blood stem cell,UCBSC） transplantation via peripheral veins in the treatment of decompensated cirrhosis.Methods：A total of 20 patients with decompensated cirrhosis received transplantation of human UCBSC.The alanine transaminase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TBIL）,albumin（ALB）,prothrombin time（PT）,and fibrinogen（FIB） were detected after the transplantation.Simultaneously,the im-provement in clinical symptoms and signs were observed after the treatment,and the survival rate and side effect of the treatment were recorded.Results：All the serum biochemical indexes remained stable 2 weeks after the transplantation,and at 4 weeks after trans-plantation,the levels of ALT and AST decreased significantly compared with that of the preoperative level（P0.05）.The liver function indexes was sig-nificant improved at 8 weeks after transplantation（P0.05）.At 12 weeks,the biochemical indexes further improved（P0.01）.Twelve weeks after the transplantation,ascites and edema of both lower extremities were relieved in 15 patients（75%）.Debili-ty and appetite were improved in 16 patients（80%） and 13 patients（65%）,respectively.At 12 weeks,the survival rate of the patients was 90%,and 2 patients died at 4 weeks and 8 weeks after the transplantation due to hepatic encephalopathy and spontaneous bacterial peritonitis respec-tively.No patient developed severe complications and adverse reactions associated with treatment.Conclusions：UCBSC transplantation via peripheral veins is a safe and effective in the treatment of decompensated cirrhosis,and it can improve the indexes of liver function and clinical symptoms and signs in the patients with decompensated cirrhosis.