不同类型自体骨髓干细胞序贯移植治疗急性心肌梗死的临床观察

Clinical observation of different types of autologous bone marrow stemcells sequential transplantation in the treatmentof acute myocardial infarction

目的:评估骨髓单个核细胞(MNC)、间充质干细胞(MSC)经梗死相关冠状动脉(IRCA)内序贯移植治疗急性心肌梗死(AMI)的临床疗效及安全性。方法:将38例行择期经皮冠状动脉介入治疗(PCI)的AMI患者随机分为移植组(17例)和对照组(21例),PCI术后通过造影导管于IRCA内分别注入MNC和等量0.9%氯化钠溶液;2周后移植组再次行MSC移植,对照组不予以干预。随访6个月,记录2组不同时期左室射血分数(LVEF)、左室舒张末期内径(LVEDd)和心肌灌注缺损面积百分比等指标,同时记录恶性心血管事件的发生情况。结果:①术后3个月,移植组LVEF和心肌灌注缺损面积百分比较术前和对照组均明显改善,而LVEDd较术前显著减小(均P<0.05);②术后6个月,移植组LVEF较术前、术后3个月和对照组均明显改善,LVEDd较术前明显减少,心肌灌注缺损面积百分比较术前和对照组均明显改善(均P<0.05);③2组恶性心血管事件发生率差异无统计学意义。结论:自体MNC、MSC经IRCA内序贯移植治疗AMI是安全有效的。

Objective：To explore the efficacy and safety of intracoronary sequential infusion of autologous bone marrow mononuclear cells （MNC） and rnesenchymal stem cells （MSC） in patients with acute myocardial infarction （ AMI ） . Method ： Thirty-eight AMI patients were randomized to intracoronary infusion of MNC （ transplantation group, n=17） or equal volume normal saline （control group, n=21） through the guiding catheter at tile end of elective percutaneous coronary intervention, and MSC was infused in the transplantation group two weeks later. Changes of left ventricular ejection fraction （LVEF）, left ventricular end-diastolic diameter （LVEDd）, perfusion defects of myocardium and malignant cardiovascular events were assessed respectively before and at three and six months after the procedure in all patients. Result= ①Three months after the procedure, LVEF and perfusion defects of myocardium in transplantation group improved significamly compared with before the procedure and control group, and LVEDd was only decreased significantly compared with before the procedure （all P〈0.05）. ② Compared with before the procedure, three months after the procedure and control group, LVEF in transplanta-tion group increased significantly in six months after the procedure; LVEDd in transplantation group in six months after the procedure was only decreased significantly compared with before the procedure, while perfusion defects of myocardium in transplantation group in six month after the procedure improved significantly compared with before the procedure and control group （all P〈0.05）.③There were no significant differences in the incidence of major cardiovascular events between transplantation group and control group during follow-up. Conclusion： Intracoronary sequential infusion of MNC and MSC is safe and effective for AMI patients.