脐带间充质干细胞经肝动脉移植治疗失代偿期肝硬化的临床研究

Clinical study of the treatment with human umbilical cord mesenchymal stem cell transplantation via hepatic artery for decompensated cirrhosis

目的探讨人脐带间充质干细胞(UC-MSC)经肝动脉途径移植治疗失代偿期肝硬化的临床疗效及安全性。方法 15例失代偿期肝硬化患者采用人UC-MSC经肝动脉途径移植治疗,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 UC-MSC移植治疗后2周,各项肝功能指标与治疗前比较无显著性差异;治疗后4周,除ALT和AST有所改善外(P均<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均<0.05),12周有显著性改善(P均<0.01)。治疗后4周大多数患者的临床症状有明显改善;12周后患者总体生存率为93%,1例患者在UC-MSC静脉移植后8周因为肝性昏迷而死亡。患者均未发生与细胞移植相关的不良反应。结论 UC-MSC经肝动脉途径移植是治疗失代偿期肝硬化的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 It is to investigate the clinical effect and safety of human umbilical cord mesenchymal stem cells（UC-MSC） transplantation via hepatic artery in the treatment of decompensated cirrhosis.Methods 15 patients with decompensated cirrhosis were treated with transplantation of human UC-MSC via hepatic artery.The levels of serum alanine transaminase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TBil）,albumin（ALB）,prothrombin time（PT）,and fibrinogen（FIB） were examined at different time points after the transplantation.Simultaneously,the improvement of clinical symptoms and signs and side effects were observed after the treatment.Results All the serum biochemical indexes remained stable in 2 weeks after the transplantation,and at 4 weeks after transplantation,the levels also had no obvious changes except of ALT and AST which decreased significantly in comparison with the preoperative level（P0.05）.Significant improvement in liver function indexes was found at 8 weeks after transplantation（P0.05）.At 12 weeks,the biochemical indexes further improved（P0.01）.Clinical symptoms of most patients were obviously improved after 4 weeks＇ treatment.At 12 weeks,the survival rate of the patients was 93%,and 1 patients died at 8 weeks after the transplantation due to hepatic encephalopathy.No patient suffered from severe complications and adverse reactions associated with treatment.Conclusion UC-MSC transplantation via hepatic artery is a safe and effective way in the treatment of decompensated cirrhosis,and it can improve significantly the indexes of liver function and clinical symptoms and signs in the patients with decompensated cirrhosis,so it is worth recommending in clinic.