人脐血干细胞经外周静脉移植治疗失代偿期肝硬化的临床研究

Clinical study of human umbilical cord blood stem cell transplantation via peripheral vein in the treatment of decompensated cirrhosis

目的探讨人脐血干细胞经外周静脉移植治疗不同程度肝硬化患者的疗效及安全性。方法失代偿期肝硬化患者65例,分为干细胞组34例,其中Child-Pugh A级13例、B级14例、C级7例,在常规保肝治疗的基础上给予脐血干细胞移植治疗;对照组31例,其中Child-Pugh A级11例、B级13例、C级7例,给予常规保肝治疗。于治疗后2、4、12及24周观察不同程度肝硬化患者肝功能和凝血功能变化,并观察临床症状改善以及不良反应发生情况。结果 (1)临床症状改善情况:Child-Pugh A、B级患者干细胞组临床症状较对照组明显改善。Child-Pugh C级患者2组临床症状改善程度差异无统计学意义。(2)肝功能和凝血功能改善情况:Child-Pugh A、B级患者干细胞组白蛋白(ALB)、凝血酶原活动度(PTA)治疗后2、4、12、24周均较治疗前升高,且干细胞组于12、24周均较对照组升高;干细胞组胆碱酯酶(CHE)治疗后4、12、24周均较治疗前升高,但与对照组比较差异无统计学意义;2组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)比较差异均无统计学意义。干细胞组Child-Pugh C级患者治疗后ALT、AST、TBIL、ALB、CHE、PTA与治疗前及对照组比较差异均无统计学意义。(3)所有患者均未发生严重不良反应及并发症。结论经外周静脉移植脐血干细胞治疗失代偿期肝硬化患者安全有效,Child-Pugh A、B级患者的疗效优于Child-Pugh C级患者。

Objective To investigate the effect and safety of human umbilical cord blood stem cell transplantation via peripheral vein in the treatment of different degrees of liver cirrhosis. Methods Sixty-five patients with liver cirrhosis were selected, and divided into stem cell group （n=34） and control group （n=31）. Stem cell group included patients with different degrees of cirrhosis： 13 with Child-Pugh A, 14 with Child-Pugh B and 7 with Child-Pugh C respectively, patients in stem cell group were given intravenous infusion of human umbilical cord blood stem ceils via peripheral vein on the basis of rou- tine treatment. The changes of liver function and coagulation function were observed before transplantation, 2, 4, 12 and 24 weeks after transplantation. In addition, clinical symptoms and side effects in patients were observed after the stem cell treat- ment. Results （1） Clinical symptoms were improved obviously in patients with Child-Pugh A and B in stem cell group com- pared with those in control group. There were no significant differences in clinical symptoms in patients with Child-Pugh C between stem cell group and control group. （2） Liver of albumin （ALB）, prothrombin activity （PTA） were significantly in- creased in patients with Child-Pugh A and B in stem cell group at 2, 4,12 and 24 weeks after treatment than those before treatment. Levels of ALB and PTA were increased in stem cell group at 12 and 24 weeks after treatment than those of control group. The level of cholinesterase （CHE） was increased in stem cell group at 4, 12 and 24 weeks after treatment than those before treatment. There was no significant differences in level of CHE between stem cells group and control group. There was no significant differences in levels of alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and total bilirubin （TBIL） between stem cell group and control group. There were no significant differences in ALT, AST, TBIL, ALB, CHE and PTA in patients with Child-Pugh C between stem cell group and control group. （3） There were no severe complications and adverse reactions in patients after treatment. Conclusion Human umbilical cord blood stem cell transplantation via periph- eral vein is safe and effective for the treatment of liver cirrhosis. The curative effect is much remarkable in patients with Child-Pugh A and B than that in patients with Child-Pugh C.