脐带血干细胞治疗肝硬化失代偿期疗效观察

Therapeutic effect of umbilical blood stem cell transplantation on patients with decompensated liver cirrhosis

目的观察脐带血干细胞治疗肝硬化失代偿期患者的临床疗效。方法肝硬化失代偿期患者16例,Child-Pugh分级均为B或C级。无菌采集正常分娩或剖宫产胎儿脐带血,分离干细胞,经肝动脉介入将干细胞悬液定植入肝脏。分别观察干细胞治疗前及治疗后2、4、12周患者临床症状、腹水、血液生化指标、凝血相关因素、甲胎蛋白等变化,测量肝脏体积改变并完成12周随访。结果经脐带血干细胞治疗后12周,患者乏力、纳差、腹胀等症状明显改善,14例患者腹水消失(87.5%),所有患者下肢浮肿消失。术后12周白蛋白合成明显增加,白蛋白水平由术前29.8g/L升至36.2g/L,增幅达6.4g/L(P<0.01);前白蛋白(PA)水平由72.46mg/L升至107.11mg/L,增幅达34.65mg/L(P<0.01);凝血酶原活动度(PTA)由46.4%升至53.26%(P<0.01)。所有患者均未发现与治疗相关的严重不良反应及并发症。有11例患者治疗12周后,肝脏体积有所增加(69.0%),平均增加幅度为9.7%。结论脐带血干细胞治疗晚期肝硬化失代偿期,可明显改善临床症状,促进腹水消退,提高肝脏合成白蛋白和前白蛋白能力,显著改善凝血功能。

Objective To investigate the clinical therapeutic effect of umbilical blood stem cell transplantation on patients with decompensated liver cirrhosis.Methods Total of 16 patients with decompensated liver cirrhosis treated with umbilical stem cells were Child-Pugh class B or C.The therapeutic stem cells were collected and isolated from the umbilical blood of fetal delivered by normal or uterine-incision woman.The isolated stem cells were transplanted into the liver via hepatic artery.The manifestation,ascites,biochemical test,prothrombinal function and AFP were observed before and after treatment for 2,4,12 weeks.The volume of liver by MRI were measured and also 12 weeks’ follow-up visit were finished.Results After 12 weeks of stem cells treatment,the clinical symptoms improved obviously.The refractory ascites disappeared in 14 cases（87.5%）;the edema of lower extremity disappeared in all patients.The albumin level were elevated from 29.8 g/L to 36.2 g/L,the amplification reached 6.4 g/L（P 0.01） ,and pre-albumin were elevated from 72.46 mg/L to 107.11 mg/L,the amplification reached 34.65 mg/L（P 0.01） .The prothrombin time activity（PTA） increased from 46.4 % to 53.26%（P 0.01） .The serious adverse effects were not observed in all patients.The liver volume detected by MRI enlarged in 11 of 16 patients（69%） ,the average amplification reached 9.7%.Conclusions Umbilical blood stem cell therapy was effective in the symptoms improvement,ascites clearance,the liver synthetic potency of albumin and pre-albumin and prothrombin function improvement on patients with decompensated liver cirrhosis.