冠状动脉内多种自体骨髓干细胞移植治疗心绞痛对比研究

Comparison of research on intracoronary transplantation with multiple autologous bone marrow stem cells for angina

目的 对比评价骨髓单个核细胞、间充质干细胞和CD34＋干细胞移植治疗心绞痛的安全性和有效性。方法72例心绞痛患者，接受目前最佳药物治疗，随机分为单个核细胞组（24例）、间充质干细胞组（24例）和CD34＋干细胞组（24例）。常规前降支病变PCI术后，进行冠状动脉内自体骨髓干细胞移植，于冠状动脉病变近端注人骨髓干细胞。所有患者于术前和术后6个月进行二维超声、单光子体层扫描（SPEC~和动态心电图检测，术中，术后3、6个月评价心肌梗死、心律失常等并发症和心绞痛的疗效。结果未观察到因冠状动脉内注射而导致的心肌梗死、心肌酶升高、心肌穿孔、心包积液、室性心动过速或室颤发生，无严重不良事件发生。从治疗有效性指标心绞痛发作频率、硝酸甘油用量、运动时间及加拿大心血管学会心绞痛分级方面评价，CD34＋干细胞组与前两组相比，差异具有统计学意义（均为P〈0．05，P〈0．01）；前两组间差异无统计学意义（P〉0．05）。结论冠状动脉内注射自体骨髓干细胞治疗心绞痛是安全和有效的，其中CD34＋干细胞移植优于骨髓间充质干细胞和骨髓单个核细胞。

Objective Comparison of evaluating the safety and efficacy of transplantation of autologous bone marrow mononucleus, mesenchymal and CD34＋ stem cells for angina. Methods Seventy-two patients who had suffered from angina, were randomly divided into three groups and intracoronary transplanted immediately following PCI with bone marrow mononucleus, mesenchymal and CD34＋ stem cells. 2-D echocardiography,singlephoton emission computed tomography （SPECT） imaging and ECG Hoher monitor were checked up before and 6 months after the procedure. The complications of AMI, arrhythmia etc, efficacy for angina were evaluated during and 3,6 months after the procedure. Results The injection of cells intracoronary did not result in myocardial infarction, cardiac enzyme elevation, perforation, or pericardial effusion. No incidence of ventrcular tachycardia or ventrieular fibrination occurred during the transplantation. There were no serious adverse events during and after the procedure. Efficacy parameters including angina frequency, nitroglycerine usage, exercise time, and Canadian Cardiovascular Society class showed that CD34＋stem cellf-3treated patients were better than the other two groups （all P〈0.05 or P〈0.01）. While there were no significant difference between bone marrow mononucleus and mesenchymal stem cells （P〉0.05）. Conclusion Intracoronary transplantation of autologous bone marrow CD34＋stem cell were better for angina than that of the other two groups. There were no significant difference for angina be- tween bone marrow mononucleus and mesenchymal stem cells.