论文部分内容阅读
目的观察经冠状动脉自体骨髓单个核细胞(mononuclearbonemarrowcell,MBMC)移植治疗缺血性心力衰竭(IHF)的可行性、效果、安全性及不良反应。方法2002年12月至2004年3月,41例缺血性心力衰竭患者入选此前瞻性研究,分为两组。(1)细胞移植组:14例经梗死相关冠状动脉超选择性移植,于气囊充盈下高压注入2mLMBMC(2×106/mL),重复注入6～8次,平均共计(3.28±0.44)×107MBMC;13例经冠状动脉选择性移植,气囊未充盈下高压注入移植细胞,细胞数与上相同。(2)对照常规治疗组:共14例,除细胞移植外其他治疗均相同。结果27例细胞移植患者手术均安全,2例于细胞注入后15～30min感发冷,30min后好转;2例细胞注入时出现短暂自限性室性早搏,术后48h持续心电监测未出现新的心律失常;随访3个月时,细胞移植组心力衰竭症状明显好转,射血分数(EF)和心搏量(SV)增加,左心室收缩末期容积(LVESV)减少,正电子发射体层摄影(PET)心肌代谢显像示代谢活力心肌增加(23.94±7.28)%(P=0.015);术后第3天、第7天脑钠素(BNP)水平较术前明显下降,心钠素(ANP)水平在术后第7天明显上升;随访6个月1例心力衰竭加重再度住院,无一例死亡。对照组心功能恶化,再入院率71.4%,2例死亡。结论自体骨髓单个核细胞经冠状动脉移植修复心肌对改善心功能是安全有效的。
Objective To observe the feasibility, efficacy, safety and adverse reactions of coronary artery transplantation of mononuclear bone marrow cell (MBMC) in the treatment of ischemic heart failure (IHF). Methods From December 2002 to March 2004, 41 patients with ischemic heart failure were enrolled in this prospective study and divided into two groups. (1) Cell transplantation group: 14 cases were transsected by infarction-associated coronary artery. Under balloon filling, 2mLMBMC (2 × 106 / mL) was injected under high pressure and repeated infusion for 6-8 times with an average of (3.28 ± 0.44) × 107MBMC ; 13 cases of selective transposition of the coronary artery, balloon inflated under high pressure injected into the cells, the same number of cells. (2) control group: a total of 14 cases, except for cell transplantation other treatment are the same. Results All the 27 patients undergoing cell transplantation were operated safely. Two cases were cold at 15-30 minutes after injection of cells and were improved after 30 minutes. Two cases of transient self-limiting premature ventricular contractions were infused into the cells and no ECG was observed at 48 hours after the operation New arrhythmia. At 3 months of follow-up, the symptoms of heart failure in the cell transplantation group were significantly improved, the ejection fraction (EF) and stroke volume (SV) increased, the left ventricular end systolic volume (LVESV) Myocardial metabolic imaging showed a significant increase of myocardial viability (23.94 ± 7.28)% (P = 0.015). On the 3rd and 7th day after operation, the level of BNP was significantly decreased compared with that before operation. The atrial natriuretic peptide (ANP) levels increased significantly on the 7th day after operation. One case of HF who was followed up for another 6 months was hospitalized without any death. The heart function of the control group deteriorated, with a readmission rate of 71.4% and two deaths. Conclusion Autologous bone marrow mononuclear cells are safe and effective in improving cardiac function by coronary artery transplantation.