急诊经冠状动脉自体骨髓单个核细胞移植对急性心肌梗死患者远期心功能的影响

Long-term efficacy of emergent intracoronary transplantation of autologous bone marrow mononuclear cells for treatment of acute myocardial infarction

目的评价急诊经冠状动脉自体骨髓单个核细胞(BM-MNC)移植能否改善急性心肌梗死(AMI)患者的远期心功能。方法将20例发病时间<24 h的AMI患者随机分成移植组(10例)和对照组(10例),分别在急诊行经皮冠状动脉介入治疗(PCI)成功后3 h内经导管注射BM-MNC或安慰剂至梗死相关冠状动脉。PCI术后1周、6个月及4年,随访患者的左心室射血分数(LVEF)、左心室舒张末期内径(LVDd)、同位素心肌灌注图像以及患者的生活质量。PCI术后4年,对照组有2例患者失访,移植组有2例患者拒绝继续随访。结果经胸超声心动图检查示,移植组的LVEF由PCI术后1周的0.538±0.092升高至6个月时的0.586±0.099(P<0.05);而对照组的差异无统计学意义(P>0.05)。对照组的LVDd由PCI术后1周的(50.4±6.0)mm显著增加至PCI术后6个月时的(55.2±7.1)mm(P<0.05);而移植组的LVDd维持不变(P>0.05)。移植组PCI术后4年的LVEF为0.639±0.064,显著高于PCI术后6个月的0.586±0.099(P<0.05);而对照组无显著变化(P>0.05)。移植组、对照组在PCI术后4年的LVDd均较术后6个月无显著变化(P值均>0.05)。单光子放射计算机断层显像术(SPECT)检查示,移植组心肌灌注缺损指数由术后的21±11显著降低至6个月时的13±10(P<0.01),而对照组无显著变化(P>0.05)。移植组在PCI术后4年的心肌梗死节段较6个月时显著减少,而对照组的差异无统计学意义(P>0.05)。两组术前与术后的生活质量评分的差异均无统计意义(P值均>0.05)。结论急诊经冠状动脉移植BM-MNC可显著改善AMI患者远期左心室收缩功能和心肌血流灌注,并可有效防止远期发生左心室扩大。

Objective To investigate the long-term effects of emergent intracoronary autologous bone marrow mononuclear cell（BM-MNC） transplantation on left ventricular function and myocardium lesion area in patients with primary acute myocardial infarction.Methods Twenty patients within 24 h after the onset of primary acute myocardial infarction（AMI） were randomly allocated to receive intracoronary autologous BMT（n=10） or bone marrow supernatant（con,n=10） immediately after primary percutaneous coronary intervention.Left ventricular ejection fraction（LVEF）,left ventricular end-diastolic internal diameter（LVDd）,myocardial radionuclide imaging and life quality were examined at 1 week,6 months and 4 years after（PCI）.Four years after PCI,2 patients were lost in the control group and 2 patient withdrew in the experiment group.Results The LVEF increased from 0.538±0.092 at 1 week after PCI to 0.586±0.099 at 6 months after PCI（P0.05） in the BMT group,but kept unchanged in the CON group（0.582±0.075 vs.0.563±0.035,P0.05）;LVDd remained unchanged（[52.5±2.8] mm vs.[52.1±3.2] mm,P0.05） in the BMT group but significantly enlarged in the CON group（[50.4±6.0] mm vs.[55.2±7.1] mm,P0.05）.After 4 years,LVEF increased to 0.639±0.064 in BMT group,significantly higher than that at 6 months（P0.05）,while it kept unchanged in the CON group（0.568±0.135 vs.0.563±0.035,P0.05）;LVDd remained unchanged in the BMT group（[51.3±2.5] mm vs.[52.1±3.2] mm,P0.05） and the CON group（[56±7.3] mm vs.[55.2±7.1] mm,P0.05）.Additionally,the myocardial perfusion defect scores decreased from 21±11 after PCI to 13±10 at 6 months after PCI（P0.01） in the BMT group,while kept unchanged in the CON group.The myocardial infarction segments decreased markedly after 4 years in BMT group while kept unchanged in the CON group.The quality of life was not significantly different before and after PCI in the two groups.Conclusion Emergent intracoronary transplantation of autologous BM-MNC in patients with acute myocardial infarction can improve the long-term left ventricular function,prevent myocardial remodeling and increase myocardial perfusion during a 4-year follow-up.