血清血管内皮细胞生长因子在急性心肌梗死自体骨髓干细胞移植治疗中的作用

Effect of VEGF on intracoronary transplantation of autologous bone marrow stem cell in patients with acute myocardial infarction

目的探讨急性心肌梗死患者自体骨髓干细胞冠状动脉内注射改善心功能的治疗中血管内皮细胞生长因子（VEGF）的作用。方法选择因急性心肌梗死住院并行介入治疗的患者25例，按照随机分组的原则分为干细胞移植治疗组和对照组，治疗组患者在心肌梗死发生14d后进行冠状动脉内注射自体骨髓干细胞治疗。术前1周和术后6个月时，采用^99mTC—MIBI心肌灌注显像、二维超声心动图评价患者心肌灌注（SPECT积分）、左室射血分数（EF％），术后第3、7、14、28、56天时酶联免疫吸附法测定患者血清VEGF（pg／ml）浓度。结果干细胞移植治疗组与对照组比较，自体骨髓干细胞移植前两组间心肌灌注及左室射血分数比较差异无统计学意义（P〉0．05）。术后6个月时心肌灌注及左室射血分数治疗组明显好于对照组（P〈0．05）。血清VEGF浓度在细胞移植后3、56d时移植治疗组与对照组比较差异无统计学意义（P〉0．05）；血清VEGF浓度在细胞移植后7、14、28d时细胞移植治疗组明显高于对照组（P〈0．05）。结论急性心肌梗死后通过自体骨髓干细胞冠状动脉内移植增加患者血清VEGF浓度，改善心肌灌注，提高患者的心功能，减少心力衰竭的发生。

Objective To investigate the effect of vascular endothelial growth factor （VEGF） on left ventricular function of intracoronary transplantation of autologous bone marrow mesenchymal stem cell in patients with acute myocardial infarction. Methods After successful percutaneous coronary intervention （PCI） for acute myocardial infarction, 25 patients were randomly assigned to either a bone - marrow - cell transplantation group that received optimum medical treatment and intracoronary transfer of autologous bone - marrow cells 14 days after PCI, or a control group that received optimum postinfarction medical treatment. Datas of myocardial perfusion imaging and left ventrieular ejection fraction （LVEF） were obtained by SPECT and echocardiogram respectively before and at 6 months＇ followed - up. The se- rum levels of VEGF were measured by ELISA at 3 - day, 7 - day, 14 - day, 28 - day, 56 - day time - points after transplantation, respectively. Results There was no significant difference between the two groups in myocardial perfusion imaging or LVEF before intracoronary transplantation of autologous bone marrow stem cell （ P 〉 0.05）. After 6 months, myocardial perfusion imaging and LVEF in treated pa- tients was improved significantly （ P 〈 0.05 ） compared with the control group. There was no significant difference between the two groups of the serum levels of VEGF at 3 - day, 56 - day point （ P 〉 0.05）. The serum levels of VEGF at 7 - day, 14 - day, 28 - day after stem cell transplantation in patients ac- cepted treatment were significantly higher than the levels in control patients（ P 〈 0.05 ）. Conclusions After intracoronary transplantation of autologous bone marrow stem cell in patients with acute myocardial infarction, the left ventricular function and myocardial infusion could be improved and the heart failure decreased by the way to increase serum level of VEGF.