自体干细胞治疗失代偿肝硬化的疗效观察

Efficacy of autologous stem cells for treatment of decompensated liver cirrhosis: A study of 96 weeks in 62 cases

目的分析自体干细胞移植治疗失代偿肝硬化的临床效果。方法回顾性分析2007年3月至2009年6月在解放军第一一三医院肝病科就诊的62例失代偿乙肝肝硬化患者,其中30例行自体干细胞移植,32例纳入对照,分别在4、12、24、96周进行随访;两组肝功指标比较用独立t检验,治疗后不同时间各肝功指标的比较用F检验及LSD两两检验,两组之间肝癌发生率和死亡率比较应用四格表c2检验。结果干细胞组治疗前及治疗后4、12、24、96周,其肝功指标白蛋白(ALB)、总胆红素(TBiL)、丙氨酸氨基转移酶(ALT)、胆碱酯酶(CHE)、凝血酶原时间(PT)和肝功能分级(CTP)值,差异有统计学意义(F=8.521、11.198、39.652、6.172、9.795,10.961,P均=0.000);对照组治疗前及治疗后4、12、24、96周,其肝功指标ALB、TBiL、ALT值,差异有统计学意义,(F=5.594、13.602、52.612,P均=0.000),而CHE、PT和CTP值,差异无统计学意义(F=0.999、1.560、2.371,P=0.410、0.188、0.055)。随访第96周,干细胞组和对照组的ALB(g/L)为35.08±7.93、30.52±5.45(t=2.524,P=0.018);TBIL(μmol/L)为32.12±19.23、35.77±17.58(t=2.008,P=0.050);ALT(U/L)为34.12±6.88、40.23±7.12(t=2.781,P=0.007);CHE(U/L)为3801.98±2012.21、2702.12±1722.70(t=2.923,P=0.008);PT(S)为14.50±4.12、18.89±4.99(t=3.625,P=0.000);CTP(分)为6.10±2.01、9.32±4.19(t=3.939,P=0.001)。差异均有统计学意义。干细胞组死亡率为6.67﹪,低于对照组的25.00﹪(c2=3.847,P=0.049),肝癌发生率两组无统计学意义(c2=0.286,P=0.594)。结论自体干细胞移植能改善失代偿肝硬化近期肝功能和降低死亡率,是一种较安全、有效的治疗方法。

Objective To evaluate the clinical efficiency of autologous stem cells （ASC） transfusion for decompensate liver cirrhosis （LC）. Methods A total of 62 chronic hepatitis 13 patients with decompensated LC, including 30 patients receiving ASC transfusion, and 32 patients receiving saline as the control, were recruited; clinical parameters were evaluated during the 96 weeks of follow-up; SPSS13.0 software was applied for analysis; parametric data were analyzed by t test; non-parametric data were carried out by c2 test between the two groups. Results At weeks 4, 12, 24, 96, there were significant improvement in patients treated with ASC transfusion compared with pretherapy, for serum albumin levels （ALB）, total bilirubin levels （TBiL）, alanine aminotransferase（ALT）, prothrombin time（PT）, cholinesterase （CHE）andchild-Turcotte-Push （CTP）（ F= 8.521, 11.198, 39.652, 6.172, 9.795, 10.961, P = 0.000）. In the control group, some parameters had significant improvement compared with pretherapy; ALB, TBIL and ALT（F= 5.594, 13.602, 52.612, P = 0.000）, other parameters were similar to pretherapy（CHE）PT and CTP （F= 0.999, 1.560, 2.371, P = 0.410, 0.188, 0.055）. At 96 week, ALB, TBIL, ALT, CHE, PT and CTP were （35.08 ± 7.93） g/L and （30.52 ± 5.45） g/L （t=2.524, P=0.018）, （32.12± 19.23） ixmol/Land （35.77± 17.58） μmol/L （t=2.008, P =0.050）, （34.12±6.88）U/Land （40.23 ± 7.12） U/L （t=2.781, P=0.007）, （3801.98 ± 2012.21） U/L and （2702.12 ± 1722.70） U/L （ t = 2.923, P = 0.008） ,（14.50 ± 4.12） S and （18.89 ± 4.99 ） S （t = 3.625, P = 0.000）, （6.10 ± 2.01） min and （9.32 ± 4.19） min for the treatment and control group respectively （t = 3.939, P = 0.001 ）Mortality in patients treated with ASC transihsion was significant lower than controls（z2 = 3.847, P = 0.049）. No significant difference in the incidence of liver cancer were observed （Z2 = 0.286, P = 0.594）. Conclusions ASC transfusion is clinically safe and could improve liver function and reduce the mortality in patients with decompensated LC. ASC transfusion, therefore, might be a novel therapeutic approach for patients with decompensated LC.