急性心肌梗死合并心衰患者应用干细胞移植的临床观察

Clinical observation of stem cell transplantation in patients with acute myocardial infarction complicated with heart failure

关键词:  心衰  急性心肌梗死  干细胞移植

Key words:  [Key words] 　heart failure  acute myocardial infarction  stem cell transplantation

摘要:

目的　观察干细胞移植在急性心肌梗死(AMI)后心衰患者中的临床疗效。方法　选择2006年8月—2010年6月收治的急性ST段抬高心肌梗死（STEMI）合并心衰，Killip分级Ⅱ级及Ⅱ级以上，常规药物治疗无效，左室射血分数(LVEF)＜45%的患者，共30例。将入选患者随机分成两组，其中干细胞移植组19例，对照组11例。移植组于PCI术后5 d行干细胞移植术，用冠脉造影注射法，采集经粒细胞集落刺激因子动员5 d的外周血干细胞（PBSC）悬液，经流式细胞仪分离计数CD+34细胞（大约1×10 10～1×10 11/L），注入梗死相关血管。对照组以同样方法于冠脉内注射等量生理盐水。观察移植组术前、术后6个月、2年、最长5年以及对照组常规治疗6个月、2年、5年的心功能情况。比较移植前后左室射血分数（LVEF）和左室舒张末期容积（LVDd）数值。结果　移植组干细胞移植后6个月左室射血分数为 （42.4±5.6）%，明显高于移植前的（38.6±5.4）%及对照组（38.7±5.1）%，P<0.05。移植组干细胞移植后6个月舒张末期容量（内径）（58.50±4.6）mm，明显小于移植前的（60.00±7.5）mm，P<0.05。结论　经皮冠状动脉内自体外周血干细胞移植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。

Abstract:

[Abstract] Objective　To study the therapeutic effects of stem cell transplantation in patients with acute myocardial infarction complicated by heart failure. Methods　We chose 30 cases who had acute ST segment elevation myocardial infarction (STEMI) complicated by heart failure, Killip class Ⅱ and Ⅱ above, unresponsive to conventional drug treatment, and left ventricular ejection fraction (LVEF) less than 45%, between August 2006 and June 2010. The patients were randomly divided into two groups including 19 patients in the stem cell transplantation group and 11 patients in the control group. The transplantation group patients received stem cell transplantation into the infarct related artery 5 days after PCI using coronary angiography injection method [Acquisition by granulocyte colony stimulating factor in peripheral blood stem cell mobilization of 5 days of suspension, after separation and counting CD34+ cells by flow cytometry（about 1×1010-1×1011/L）]. The control group were injected the equal amount of saline solution into the coronary artery using the same method. Cardiac function was measured preoperatively and at 6 month, 2 year and 5 year after operation. The left ventricular ejection fraction（LVEF）and left ventricular end diastolic volume value（LVDd） were compared before and after operation. Results　The left ventricular ejection fraction at 6 month after operation in the transplantation group （42.4±5.6）% was significantly higher than the value before transplantation（38.6±5.4)% and that in the control group（38.7±5.1)%，P<0.05. The end diastolic volume (Inside diameter) at 6 month after operation（58.50±4.6)mm in the transplantation group was significantly less than the value before transplantation (60±7.5）mm, P<0.05. Conclusion　Percutaneous intracoronary autologous peripheral blood stem cell transplantation can significantly improve left ventricular function in patients with acute myocardial infarction, reduce left ventricular volume, and delay or prevent left ventricular remodeling. This new therapy is safe and effective.