自体骨髓干细胞移植治疗心肌梗死临床探究.docVIP

自体骨髓干细胞移植治疗心肌梗死临床探究 　 作者：杨承健,张郁青,徐欣,胡世文,曹佳宁,张月军,黄伟,金艳,张馥敏,杨志健 【关键词】 骨髓干细胞;细胞移植;心肌梗死 　　[摘要]目的 研究自体骨髓干细胞经冠脉移植对心肌梗死患者心功能的影响及其安全性。方法 6例冠心病伴心肌梗死患者，男5例、女1例，平均年龄62岁（51~75岁），体外分离培养自体骨髓干细胞2~3周，开通梗死相关“罪犯”血管，通过冠脉转运将骨髓干细胞植入患者的心肌梗死区，移植的骨髓间充质干细胞数为（0.9~3.2）×106个，骨髓单个核细胞数为（1.6~5.3）×106个。术前和术后6个月分别行99mTcMIBI心肌灌注显像、二维超声心动图、心电图和动态心电图检查。结果 6例患者二维超声心动图检查示左室射血分数(LVEF)较术前明显增加[（52.33±8.70）% vs (42.92±12.60)%,Plt;0.05]，左室舒张期内径（LVDd）较术前明显减少[（54.33±4.84) vs (61.67±6.83),Plt;0.05]；6例99mTcMIBI检查显示梗死部位心肌灌注明显改善。术中及术后随访6~18个月无心律失常和其他合并症发生。结论 进行自体骨髓干细胞经冠脉移植治疗冠心病、心肌梗死具有抑制左室重构、改善心脏功能的作用。 　　[关键词]骨髓干细胞;细胞移植;心肌梗死 　　Clinical research for treatment of myocardial infarction with autologous bone marrow stem cell transplantation 　　Abstract:Objective To evaluate the efficacy and safety of transplantation of autologous bone marrow mesenchymal stem cells(BMSCs) and mononuclear cells(BMMNCs) for treating myocardial infarction.MethodsSix patients suffered from coronary heart disease with myocardial infarction were enrolled.In 6 patients BMSCs+BMMNCs were transplanted immediately following PCI.Autologous BMSCs+BMMNCs were isolated and cultured for 2~3 weeks.BMSCs ［(0.9~3.2)×106 ］ and BMMNCs ［(1.6~5.3)×106］ were transplanted through the intracoroary way.Cardiac functions were determined by 2Dechocardiography，technetium99m methoxyisobutylisonitrile (99mTc MIBI) and ECG Holter monitor before and 6 months after the procedure,respectively.Results Left ventricular ejection fraction(LVEF) significantly increased ［（52.33±8.70）% vs (42.92±12.60)%, Plt;0.05］and left ventricular diastolic diameter(LVDd) reduced ［（54.33±4.84） vs (61.67±6.83), Plt;0.05］.Neither obvious arrhythmia nor other complication was observed during 6~18 months follow up in all 6 patients.Conclusions The preliminary study has shown that in the patients suffered from coronary heart disease complicated with myocardiac infarction,transplantation of BMSCs+BMMNCs can improve cardiac function without significant complications and arrhythmia during 6~18 months