急性心肌梗死患者自体骨髓干细胞移植治疗效果随访

Long-term efficacy of intracoronary stem cells transplantation in patients with acute myocardial infarction

目的:研究急性心肌梗死(Acute myocar-dial infarction,AMI)患者自体骨髓间质干细胞(Mesenchymal stem cells,MSCs)冠脉内注射治疗的安全性以及对心功能的改善作用,并探讨其可能机制。方法:20例急性心肌梗死患者(治疗组)经皮冠状动脉介入(PCI)术后抽取骨髓分离、培养、扩增后12～14d行冠脉内注射,另选取20例PCI术后拒绝行细胞治疗的急性心肌梗死患者作为对照组,PCI术后1周及1年进行临床随访、超声心动图及18氟-脱氧葡萄糖单光子心肌断层显像(18F-FDG-SPECT)。结果:治疗组未见与移植有关的体温升高及恶性心律失常发生。与对照组比较,1年后治疗组超声心动图心脏收缩、舒张功能指标及SPECT代谢缺损指标有明显改善,差异具有统计学意义(P<0.05)。结论:急性心肌梗死患者自体骨髓间质干细胞冠脉内注射安全有效,可以改善患者心功能及远期预后;骨髓来源的心肌细胞生成及血管新生可能为其机制。

ABSTRACT AIM： To investigate the security as well as the improvement of cardiac function in patients with acute myocardial infarction who ac-cepted intracoronary transplantation of autolo-gous bone marrow mesenchymal stem cells （MSCs） ,and to discuss the possible mechanism.METHODS： 20 cases of acute myocardial infarc-tion patients after percutaneous coronary inter-vention （PCI） received intracoronary transplan-tation of MSCs. （treatment group）. Another 20 patients who refused stem-cell therapy after PCI served as control （conrol group）. All patients underwent clinical evaluation, 2D/TDI echocar- diogram, and ~SF-FDG-SPECT at 1 week/1 year after PCI. RESULTS ： Body temperature elevation or malignant arrhythmia associated with trans-plantation was not found in treatment group. Compared with the control group, echocardio-graphic systolic and diastolic function parameters and SPECT metabolic defects indicators were improved significantly in treatment group 1 year after PCI, there were statistical differences （P〈 0.05）. CONCLUSION： Intracoronary transplan- tation of MSCs is safe and effective, and may significantly improve long-term cardiac perform-ance. MSCs-associated myocardial regeneration and neovascularization may be the possible mechanisms.