自体骨髓干细胞移植治疗心肌梗死的临床研究.doc

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1、自体骨髓干细胞移植治疗心肌梗死的临床研究作者：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(5厂75岁)，体外分离培养自体骨髓干细胞2一3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(0.9一3・2)x106个，骨髓单个核细胞数为(1・6一5・3)x106个。术前和术后6个月分别行99mTcMTBT心肌灌注显像、二维超声心动图、

2、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)较术前明显增力口[(52.33±8.70)%vs(42.92±12.60)%,P<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),P<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。Clinicalresearchfortreatmentofmyocardialinfarcti

3、onwithautologousbonemarrowstemcel1transplantationAbstract:ObjectiveToevaluatetheefficacyandsafetyoftransplantationofautologousbonemarrowmesenchymalstemcelIs(BMSCs)andmononuclearcells(BMMNCs)fortreatingmyocardialinfarction.MethodsSixpatientssufferedfromcoronaryheartdiseasewithmyocardialinfarctionw

4、ereenrolled.In6patientsBMSCs+BMMNCsweretransplantedimmediatelyfollowingPCI.AutologousBMSCs+BMMNCswereisolatedandculturedfor23weeks.BMSCs[(0.93.2)x106]andBMMNCs[(1.65.3)x106]weretransplantedthroughtheintracoroaryway.Cardiacfunctionsweredeterminedby2Dechocardiography,technetium99mmethoxyisobutyliso

5、nitrile(99mTcMIBI)andECGHoltermonitorbeforeand6monthsaftertheprocedure,respectively.ResultsLeftventricularejectionfraction(LVEF)significantlyincreased[(52.33±8.70)%vs(42.92±12.60)%,P<0.05]andleftventriculardiastolicdiameter(LVDd)reduced[(54.33±4.84)vs(61.67土6.83),P&It;0.05].Neitherobviousarrhy

6、thmianorothercomplicationwasobservedduring618monthsfollowupinal16patients.ConclusionsThepreliminarystudyhasshownthatinthepatientssufferedfromcoronaryheartdiseasecomplicatedwithmyocardiacinfarction，transplantationofBMSCs+BMMNCscanimprovecardiacfunctionwithoutsignificantcomplicationsandarrhythmiadu

7、ring618monthsfollowup・Keywords:bonemarrowstemcelIs;cel1transplantation;myocardialinfarction(ModernMedicalJournal,2007,35:710)干细胞移植为冠心病提供了一个崭新的治疗途径。大量动物实验证实，干细胞移植可以改善心功能［18］。自体骨髓干细胞移植因来源丰富，没有免疫排斥作用，因而备受临床医师重视［910］。我们与南京