自体骨髓单个核细胞移植治疗后重度缺血性心力衰竭患者血浆Apelin水平变化及其临床意义

Plasma apelin level and its clinical significance following autologous bone marrow mononuclear cell transplantation in patients with severe ischemic heart failure

目的研究骨髓单个核细胞(BMMC)移植治疗前后缺血性心力衰竭(IHF)患者血浆Apelin水平及心功能的变化。方法纳入40例IHF患者,分为自体骨髓单个核细胞(BMMC)移植组(n=20)及常规治疗组(n=20),分别行BMMC移植及内科常规治疗,另选择20例心功能正常者作为健康对照组。检测各组血浆Apelin、脑钠肽(BNP)基线水平及两组IHF患者经治疗后的血浆Apelin、BNP水平。两组IHF患者治疗前后行超声心动图检查。结果治疗前,与健康对照组比较,BMMC移植组和常规治疗组患者血浆Apelin基线水平均显著降低(P<0.01),血浆BNP基线水平均显著升高(P<0.01),而两组IHF患者间差异无统计学意义(P>0.05)。BMMC移植组移植后患者NYHA分级降低,24h尿量增多,常规治疗组无明显变化。BMMC移植组治疗后7d,患者血浆Apelin水平较基线水平明显升高(P<0.05),21d则显著升高(P<0.01);常规治疗组患者血浆Apelin水平治疗前,治疗后72、1d差异无统计学意义(P>0.05)。7d时BMMC移植组患者血浆Apelin水平高于常规治疗组(P<0.05),21d这种差异则更加显著(P<0.01)。BMMC移植组治疗后7d,患者血BNP水平与移植前比较明显下降(P<0.05),21d时仍明显降低(P<0.05),而常规治疗组患者血浆BNP水平治疗前、治疗后7d和治疗后21d差异无统计学意义(P>0.05)。7d和21d时BMMC移植组患者血浆BNP水平均低于常规治疗组(P<0.05)。结论经BMMC移植治疗后重度IHF患者心功能明显改善,Apelin升高可能是这种改善的重要效应。

Objective To study the change in plasma apelin level in different states of cardiac function,and before and after its treatment in patients with severe ischemic heart failure（IHF）.Methods Forty patients with IHF were assigned to the autologous bone marrow mononuclear cell（BMMC） transplantation group and conventional therapy group（20 each）,and they underwent BMMC transplantation and conventional therapy respectively.Another 20 healthy subjects with normal heart function served as normal control.The baseline data of plasma apelin level and brain natriuretic peptide（BNP） of each group were collected,and the plasma apelin level and BNP of the two IHF groups were determined after treatment.For all the patients with IHF,echocardiogram was recorded before and after treatment.Results Before treatment,the plasma apelin level was significantly lower and the baseline level of plasma BNP was obviously higher in both BMMC transplantation and conventional therapy groups than in healthy control group（P〈0.01）,while no significant difference was noted between the two IHF groups（P〉0.05）.After BMMC transplantation,the NYHA class declined and 24h urine output increased in BMMC group,but no evident change was found in conventional therapy group.In BMMC transplantation group,the plasma apelin level increased significantly 5 days after treatment（P〈0.05）,and increased threefold and higher 21 days after treatment（P〈0.01）;while no significant difference was found in conventional therapy group among the plasma apelin levels before and 7 and 21 days after treatment（P〉0.05）.Compared between the two IHF groups,the plasma apelin level was higher 7 days after treatment（P〈0.05）,and ever much higher 21 days after treatment（P〈0.01） in BMMC transplantation group than in conventional therapy group.The plasma BNP level declined significantly 7 and 21 days after treatment（P〈0.05） in BMMC transplantation group,while no significant difference was found in conventional therapy group（P〉0.05）.Compared between the two IHF groups,the plasma BNP level was lower in BMMC transplantation group than in conventional therapy group at both 7 and 21 days after treatment（P〈0.05）.Conclusion BMMC transplantation may obviously improve the cardiac function of patients with severe IHF by increasing the plasma apelin level.