粒细胞集落刺激因子对失代偿期肝硬化患者骨髓干细胞的动员效果及安全性观察

Safety and efficacy of intravenous injection of granulocyte colony stimulating factor for mobilization of autologous bone marrow stem cells in patients with decompensated cirrhosis

目的观察失代偿期肝硬化患者行自体骨髓干细胞移植前粒细胞集落刺激因子（G-CSF）对骨髓干细胞的动员效果及安全性。方法在51例失代偿期肝硬化患者行自体骨髓干细胞经肝动脉移植术前,连续2 d给予G-CSF 4μg/（kg·d）动员骨髓干细胞。抽取骨髓的当日化验血常规、肝肾功等指标;从患者髂后上棘抽取骨髓150-200 ml,分离收集骨髓单个核细胞并计数,应用流式细胞仪检测CD34＋细胞并计数,观察应用G-CSF期间不良反应的类型和发生率。患者治疗前后比较采用配对t检验进行统计学分析。结果G-CSF皮下注射后,外周血白细胞由术前（3.31±0.96）×10^9/L升至（11.35±1.92）×10^9/L（P〈0.01）,骨髓单个核细胞数（1.91±0.83）×10^9/kg,CD34＋细胞为（2.02±1.29）×10^7/kg;患者皮下注射后,发热率17.6﹪,体温最高38℃,停药后降至正常;腹部胀痛3例,四肢皮肤散发皮疹2例,均未给予特殊处理,2-3 d后恢复正常。结论给予G-CSF皮下注射后提取骨髓干细胞移植治疗失代偿期肝硬化的是一种临床确切有效的、安全的干细胞动员方法。

Objective To evaluate the safety and efficacy of autologous bone marrow stem cells mobilization by intravenous injection of granulocyte colony stimulating factor （G-CSF） in patients with decompensated cirrhosis. Methods Fifty-one patients with decompensated cirrhosis received intravenous injection of G-CSF （4 μg/kgod） before stem cell transplantation for 2 days. 150-200 ml of bone marrow was harvested from each patient. FACS was used to evaluated CD34＋ cells after mononuclear cells were isolated from the bone marrow. During the period of treatment, adverse events including bone pain, fever, gastrointestinsuza! discomforts were recorded. Kidney and liver function were evaluated. Paired t-test was used to compare the parameters before and after G-CSF injection. Results After injection of G-CSF, peripheral white blood cells rose from（3.31 ± 0.96）× 10^9/L to（ 11.35 ± 1.92）× 10^9/L （P 〈 0.01 ）. Bone marrow mononuclear cells were（ 1.91 ± 0.83 ）× 10^9/kg and CD34＋ cells were（2.02 ± 1.29）× 10^7/kg. The incidence of complications during G-CSF treatment was 17.6 % for fever and 6.90 % for abdominal pain. Skin rash was observed in 2 patients. All patients recovered well within 2-3 days without treatment. Conclusions In patients with decompensated cirrhosis, intravenous injection of G-CSF to mobilize autologous bone marrow stem cells is feasible and safe.