自体骨髓单个核细胞移植治疗心绞痛的临床研究

Clinical research for treatment of angina with autologous bone marrow mononuclear celltransplantation

目的评价自体骨髓单个核细胞（BMMNC）移植治疗心绞痛的安全性和有效性。方法15例不稳定型心绞痛患者在接受目前最佳药物治疗的基础上，于常规经皮冠状动脉介入治疗（PCI）后，进行冠状动脉内自体BMMNC移植，于冠状动脉病变近端注入自体BMMNc（BMMNc治疗组）。随机入选16例不稳定型心绞痛患者，仅接受常规药物治疗和PCI（~细胞治疗组）。以上所有患者于术前和术后6个月进行二维超声、单光子发射型计算机体层摄影（SPECT）和动态心电图检测。术中，术后3、6个月评价有无心肌梗死、心律失常等并发症和进行心绞痛的疗效评价。结果未观察到因冠状动脉内注射BMMNC而导致的心肌梗死、心律失常等严重不良事件发生。术后3个月，BMMNC治疗组每周硝酸甘油用量变化显著低于非细胞治疗组、运动时间变化高于非细胞治疗组（P〈0．05）。术后6个月，BMMNC治疗组每周心绞痛发作次数、每周硝酸甘油用量变化、加拿大心脏病学会（ccs）心绞痛分级变化均显著低于非细胞治疗组[分别为（12．6±9．3）次／周比（18．0±16．3）次，周，（-4．1±14．7）mg／周比（4．8±37．9）mg／周，（-1．4±1．0）级比（一0．8±1．7）级]，运动时间变化高于非细胞治疗组[（2．5±1-3）min比（2．0±2．1）min]（P〈0．05）。结论冠状动脉内注射自体BMMNC治疗心绞痛是安全和有效的。

Objective To evaluate the safety and efficacy of transplantation of autologous bone marrow mononuclear cell （BMMNC） for angina. Methods Fifteen patients who had suffered from unstable angina were selected to receive intracoronary transplantation immediately following percutaneous coronary intervention （PCI） with BMMNC （BMMNC group）. Sixteen patients who had suffered from unstable angina only received treatment of regular medicine and PCI （non-BMMNC group）. Two-D echocardiography, singlephoton emission computed tomography （SPECT） imaging and Holter monitoring electrocardiogram were checked up before and 6 months after the procedure. The complications of myocardial infarction, arrhythmia etc, efficacy for angina were evaluated during the procedure and 3, 6 months after the procedure. Results The intracoronary injection of BMMNC did not result in myocardial infarction and arrhythmia during the transplantation. Efficacy parameters including nitroglycerine usage per week, exercise time 3 months after the procedure showed that BMMNC group were better than non-BMMNC group （P 〈 0.05 ）. Efficacy parameters including angina frequency per week, nitroglycerine usage per week, exercise time, and Canadian Cardiovascular Society class 6 months after the procedure showed that BMMNC group were better than nonBMMNC group [ （12.6±9.3 ） times/week vs. （18.0± 16.3） times/week, （-4.1±14.7） mg/week vs. （4.8±37.9） mg/week, （2.5±1.3） min vs. （2.0±2.1 ） min, （-1.4±1.0） grades vs. （-0.8±1.7） grades] （P〈 0.05）. Conehlsion Intracoronary transplantation of autologous BMMNC is safe and efficient for angina.