自体骨髓干细胞治疗失代偿期肝硬化的临床观察

The clinical research on autonomous bone marrow stem cells to treat decompensated cirrhosis

目的观察经肝动脉行自体骨髓干细胞治疗失代偿肝硬化患者的临床疗效及安全性。方法将我科2009年11月～2011年2月的住院乙型肝炎肝硬化失代偿患者50例配对分为2组。治疗组25例,对照组25例。治疗组,抽取自体骨髓200 ml,体外分离纯化骨髓干细胞制成10 ml细胞悬液,经肝动脉注入肝脏,分别在治疗后第4、8、16周观察实验室指标、临床症状体征及不良反应,并与对照组进行比较。结果治疗组治疗后所有患者症状均有不同程度改善,治疗后8周内腹水减轻16例(80%),食欲改善18例(90%),乏力好转19例(95%),腹胀减轻18例(90%)。对照组8周腹水减轻10例(50%),食欲改善12例(60%),乏力好转10例(50%),腹胀减轻8例(40%)。治疗组患者在干细胞治疗后第4周实验室指标开始出现变化,至第8周多项指标出现显著变化,治疗8周和16周时ALT、TBil、白蛋白(Alb)、总胆固醇(CHO)、凝血酶原时间(PT)与治疗前相比差异有统计学意义。治疗组与对照组在8周和16周时,ALT、TBil、PT、CHO各项指标相比,差异均有统计学意义。治疗前后CTP评分及MELD评分变化,从第4周开始,患者分值下降较为明显,到第8周和16周时变化最为明显,与治疗前比差异有统计学意义,治疗组和对照组相比差异也有统计学意义。25例患者术中未发生严重并发症,近期无不良反应出现。结论自体骨髓干细胞治疗肝功能衰竭期患者临床疗效肯定,安全性良好,可作为中晚期肝硬化患者的临床治疗手段。

Objective To evaluate the the clinical efficacy and safety of trans-artery intrahepatic autonomous bone marrow stem cell treatment in patients with decompensated liver cirrhosis. Methods 50 hospitalized patients with decompensated liver cirrhosis in our department from November 2009 to February 2011 were divided into 2 matched groups.There were 25 patients in the treatment group,25 patients in the control group.Bone marrow 200 ml were extracted from patients in treatment group,and bone marrow stem cells were purified in vitro and made into 10 ml cell suspension,then injected into the liver through the hepatic artery.The laboratory parameters,clinical signs and symptoms of adverse reactions were observed respectively at the 4,8,16 weeks after treatment compared with the control group.Results After treatment,all patients＇ symptoms were improved.After 8 weeks treatment,the symptom of ascites in 16 cases was decreased（80%）,the appetite in 18 cases was improved（90%）,the symptom of fatigue in 19 cases was improved（95%）,the symptom of abdominal distension in 18 cases was alleviated（90%）.After 8 weeks treatment in control group,the symptom of ascites in 10 patients was decreased（50%）,the appetite in 12 cases was having been improved（60%）,the symptom of fatigue in 10 cases was improved（50%）,the symptom of abdominal distension in 8 cases was alleviated（40%）.The laboratory parameters in patients in treatment group were changed after 4 weeks stem cell treatment,to 8 weeks a number of indicators showing significant change.After 8 weeks and 16 weeks treatment,the alanine aminotransferase（ALT）、Total bilirubin（TBil）、 albumin（Alb）,、total cholesterol（CHO）,prothrombin time（PT） show significant difference compared with before treatment.At 8 weeks and 16 weeks in treatment group and control group,the indicators of ALT、Alb、TBil、PT、CHO,were statistically significant.CTP score changes before and after treatment,starting from the 4th week,patients with CTP score dropped significantly.To 8 weeks and 16 weeks,the changes were most obvious,compared with before treatment there was significant difference.Treatment group and control group also had significant differences.MELD score from 4 weeks after treatment began to decline,after treatment 8th week and when 16 week,compared with before treatment there was significant difference,compared with the control group are also significant differences.25 cases did not occur in patients with serious complications,and no adverse reactions appeared recently.Conclusion Autonomous bone marrow stem cell to treat patients with liver failure treatment is effective and clinical,security good,as a means in the clinical treatment of patients with advanced liver cirrhosis.