脐带间充质干细胞治疗慢性扩张型心肌病合并心力衰竭疗效观察

Clinical efficacy of umbilical cord mesenchymal stem cells for treatment of chronic dilated cardiomyopathy complicated with systolic heart failure

目的评价脐带间充质干细胞(MSCs)治疗慢性扩张型心肌病合并收缩性心力衰竭患者的临床效果。方法选择2013年12月至2014年12月河南省人民医院收治的59例扩张型心肌病合并收缩性心力衰竭患者,将患者分为治疗组(30例)和对照组(29例)。治疗组患者在药物治疗基础上经冠状动脉注入脐带MSCs 20 m L;对照组患者在药物治疗基础上经冠状动脉注入等量生理盐水。治疗后1、6个月观察2组患者心功能变化、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、6 min步行距离、血清氨基末端脑钠肽前体(NT-pro BNP)和再次住院率、病死率。结果 2组患者治疗后1、6个月纽约心脏病协会(NYHA)心功能分级较治疗前均有所改善(P<0.05);治疗后1、6个月治疗组患者NYHA心功能分级均显著优于对照组(χ2=12.64、16.75,P<0.05)。治疗前2组患者LVEDD、LVEF、血清NT-pro BNP和6 min步行距离比较差异均无统计学意义(P>0.05);2组患者治疗后1、6个月LVEDD、LVEF、血清NT-pro BNP和6 min步行距离与治疗前比较差异均有统计学意义(P<0.05);治疗后1个月治疗组患者LVEDD与对照组比较差异无统计学意义(P>0.05),LVEF、6 min步行距离较对照组显著增加,血清NT-pro BNP水平较对照组显著降低(P<0.05);治疗后6个月治疗组患者LVEDD、血清NT-pro BNP水平较对照组显著降低,LVEF、6 min步行距离较对照组显著增加(P<0.05)。6个月随访结果显示,对照组患者病死率为24.14%(7/29),治疗组患者病死率为6.67%(2/30),治疗组患者病死率显著低于对照组(χ2=4.99,P<0.05);对照组患者的再次住院率为31.03%(9/29),治疗组患者的再次住院率为16.67%(5/30),2组患者再次住院率比较差异无统计学意义(χ2=1.68,P>0.05)。结论脐带MSCs可改善慢性扩张型心肌病合并心力衰竭患者的心功能和心室重构,降低短期病死率。

Objective To evaluate the clinical effect of umbilical cord mesenchymal stem cells （MSCs） for treatment of chronic dilated cardiomyopathy complicated with systolic heart failure.Methods Fifty-nine patients with chronic dilated cardiomyopathy and systolic heart failure in Henan Provincial People＇s Hospital from December 2013 and December 2014 were selected and divided into treatment group （n =30）and control group （n =29）.All patients were given routine drug treatment.Based on this,the patients in treatment group were given umbilical cord MSCs 20mL by intracoronary transplantation;the patients in control group were given the same volume of saline.The changes of cardiac function,left ventricular ejection fraction （LVEF）,left ventricular end diastolic diameter（LVEDD）,6 minutes walking distance,the amino-terminal pro-brain natriuretic peptide （NT-proBNP） levels,the re-hospitalization rate,mortality rate of patients in the two groups were observed and compared at 1 month and 6 months after treatment.Results The cardiac function grading of the New York Heart Association （NYHA）of patients in the two groups were improved at 1 month and 6 months after treatment （P 〈 0.05）;the NYHA cardiac function grading of patients in the treatment group was significantly better than that in the control group at 1 month and 6 months after treatment （χ^2 =12.64,16.75;P 〈 0.05）.There was no statistic difference in LVEDD,LVEF,serum level of NT-proBNP and 6-min walking distance of patients between the two groups before treatment （P 〉 0.05）.There was statistic difference in LVEDD,LVEF,serum level of NT-proBNP and 6-min walking distance of patients in the two groups before treatment and 1 month,6 months after treatment（P 〉 0.05）.There was no statistic difference in LVEDD of patients between the two groups at 1 month after treatment （P 〉 0.05）;the LVEF,6-min walking distance of patients in the treatment group were significantly higher than those in the control group,but the serum level of NT-proBNP of patients in the treatment group was significantly lower than that in the control group at 1 month after treatment （P 〈 0.05）.At 6 months after treatment,the LVEDD,serum level of NT-proBNP of patients in the treatment group were significantly lower than those in the control group,but the LVEF and 6-min walking distance of patients in the treatment group were significantly higher than those in the control group （P 〈 0.05）.The mortality rate of patients in the treatment group （6.67%,2/30） was significantly lower than that in the control group （24.14%,7/29） （x2 =4.99,P 〈 0.05）.The re-hospitalization rate of patients in the treatment group and control group was 16.67% （5/30） and 31.031.（9/29） respectively;there was no statistic difference in the re-hospitalization rate of patients between the two groups （x2 =1.68,P 〉 0.05）.Conclusion Umbilical cord MSCs can improve the cardiac function and cardiac remodeling,reduce the mortality rate of patients with chronic dilated cardiomyopathy complicated with systolic heart failure.