38例慢性肝衰竭患者经干细胞治疗48周效果观察

Stem cell transplantation for chronic liver failure: a report of 38 cases over 48 weeks

目的通过外周血单个核细胞与脐带间充质干细胞治疗对慢性肝衰竭患者超过48周疗效以探索干细胞治疗肝衰竭的应用前景。方法选取2006年11月至2011年12月期间在青岛市传染病医院住院的78例慢性肝衰竭患者,其中38例慢性肝衰竭患者为移植组,31例进行自体外周血单个核细胞移植、7例进行脐带间充质干细胞移植,通过肝动脉介入将干细胞注入患者肝脏,观察移植48周后患者临床症状改善情况及肝脏功能恢复情况。40例慢性肝衰竭患者常规治疗作为对照组。采用t检验与c2检验,比较移植组与对照组间各临床疗效指标的差异性。结果干细胞移植后腹水消失或减少者34例(89.4﹪),食欲改善者36例(94.7﹪),体力好转者36例(94.7﹪),腹胀消失者29例(76.3﹪),与对照组比较无显著差异;PTA水平由平均26.1﹪升至54.9﹪(t=123.5,P=0.003),白蛋白逐渐升高,由平均25.3μmol/L升至34.5μmol/L(t=20.8,P<0.05)。移植组child评分由13.2±2.4降至7.0±2.1(P<0.001),对照组child评分无显著变化。与对照组相比干细胞移植后患者肝功能明显改善。38例移植患者中未发现严重并发症。结论通过对外周血单个核细胞与脐带间充质干细胞移植治疗后患者48周观察,证明干细胞移植对慢性肝衰竭患者治疗后肝功能明显改善,死亡率降低,提高生活质量。

Objective To evaluate the efficacy and safety of autologous peripheral blood mononuclear cell and mesenchymal stem cell transplantation for chronic liver failure patients over 48 weeks. Methods In 38 patients of chronic hepatic failure, 31 patients were treated by autologous peripheral blood mononuclear cell transplantation, the other 7 patients were treated by mesenchymal stem cell transplantation in addition to standard treatments. 40 patients with chronic hepatic failure as control group and received standard treatments. We transplanted the peripheral blood mononuclear cell and mesenchymal stem cell into hepatic artery through a femoral artery catheter. Liver function of patients was evaluated after 48 weeks after transplantation. Improvements of clinical symptoms and liver function were caompared. Results Most patients＇ clinical performance improved significantly after transplantation, Ascites disappeared or decreased in 34 cases （89.4%）; Appetite improved in 36 cases （94.7 %）; Physical strength improved in 36 cases （94.7 %）; Abdominal distension disappeared in 29 cases （76.3 %）. The average PTA level increased from 26.1% to 54.9 %; Albumin level gradually increased, which rose from 25.3 μmol/L to 34.5 panol/L in average. Compared with the control group, the liver function improved significantly in transplanting group. No seriouscomplications occurred during and after transplantation in all patients. But most patients showed transient fever and bone pain in the mobilization process. Conclusions Through a long-term observation, we found that the transplantation of autologous peripheral blood mononuclear cell and umbilical cord mesenchymal stem cell waw safe and effective for patients of hepatic failure. After transplantation, the liver function was improved notablely, the clinical symptoms were alleviated, the mortality decreased and the quality of life was improved.