干细胞移植急性心肌梗死合并心力衰竭患者的心功能变化:2年随访(英文)

Clinical observation of cardiac function in patients with acute myocardial infarction complicated with heart failure undergoing stem cell transplantation: a 2-year follow-up visit

背景:很多动物实验和临床试验均证实,干细胞移植可改善心脏功能,减少心室扩张及心室重构,在治疗心肌梗死合并心衰方面已经表现出传统治疗方法所无可比拟的优越性。目的:观察单次自体外周血干细胞移植在急性心肌梗死后心衰患者中的临床疗效。方法:选择2005年8月至2006年9月收治的急性ST段抬高心肌梗死合并心衰患者23例,将入选者分成两组,细胞移植组11例,对照组12例,均急诊行冠状动脉造影及药物洗脱支架置入(PCI)。细胞移植组于支架置入后5 d,采集经粒细胞集落刺激因子动员5 d的外周血干细胞(CD34+细胞,大约1×108),用冠脉造影注射法注入梗死相关血管。细胞移植后随访2年,观察患者心功能变化及不良反应。结果与结论:细胞移植组移植前与随访至6个月时相比,心功能明显改善(P<0.05),左室射血分数提高(6.2±0.2)%,左室舒张末期容积减少(4.7±2.9)mm,而移植后随访至1年、2年时结果并无明显区别(P>0.05),未发现细胞移植的不良反应。对照组随访至6个月时,左室射血分数下降(0.5±0.1)%,左室舒张末期容积增大(0.4±0.3)mm,并且逐年恶化。证实经皮经冠状动脉内自体外周血干细胞单次移植6个月时,能明显改善急性心肌梗死患者的左室功能,减小左室容量,阻止或延缓左室重构,且安全有效,但随访至2年,心功能没有得到进一步的改善。

BACKGROUND： Many animal experiments and clinical trials have demonstrated that stem celltransplantation can improve heart function and reduce ventricular dilatation and ventricular remodeling, which has shown an incomparable superiority over traditional therapies in the treatment of myocardial infarction complicated by heart failure. OBJECTIVE; To observe the clinical effects of single autologous peripheral blood stem cell transplantation in acute myocardial infarction patients with heart failure. METHODS： Since 2006 August to 2010 June, 23 patients who were diagnosed to have acute ST elevation myocardial infarction complicated with heart failure were selected and divided into two groups： cell transplantation group （n=11） and control group （n=12）. All patients underwent emergency coronary angiography and percutaneous coronary intervention with drug eluting stent implantation. In the stem cell transplantation group, peripheral blood stem cells positive for CD34 （about 1 ×10^8） were collected mobilized by granulocyte colony stimulating factor at 5 days after stent implantation, and then the cells were injected into infarcted vessels using coronary angiography method. Two-year follow-up was performed after cell transplantation to observe the cardiac function and adverse reactions in patients. RESULTS AND CONCLUSION; After 6 months of follow-up, the cardiac function in the cell transplantation group was improved significantly compared with that before cell transplantation （P 〈 0.05）, and the left ventricular ejection fraction was increased by （6.2±0.2）% and the left ventricular end diastolic volume was reduced by （4.7±2.9） mm. However, there was no difference in follow-up results by the end of 1 and 2 years after cell transplantation （P 〉 0.05）, as well as no adverse reaction occurred. In the control group, after 6 months of follow-up, the left ventricular ejection fraction was reduced by （0.5±0.1）% and the left ventricular end diastolic volume was increased by （0.4±0.3） mm, which were deteriorated year after year. Percutaneous coronary intervention with autologous peripheral blood stem cell transplantation can significantly improve the left ventdcular function, reduce left ventricular volume, and delay or prevent left ventricular remodeling in patients with acute myocardial infarction, which is safe and effective. But up to 2 years after cell transplantation, the cardiac function shows no further improvement.