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目的:研究急性心肌梗死(acutemyocardialinfarction,AMI)患者自体骨髓间质干细胞(mesenchymalstemcells,MSCs)冠状动脉内注射治疗的安全性以及对心功能的改善作用,并探讨可能机制。方法:10例急性心肌梗死患者(干预组)经皮冠状动脉介入(PCI)术后抽取骨髓分离、培养、扩增后12～14d行冠状动脉内注射,选取10例PCI术后拒绝行细胞治疗的AMI患者作为对照组,PCI术后1周及3个月进行临床随访、超声心动图及18氟-脱氧葡萄糖单光子心肌断层显像。结果:治疗组未见与移植有关的体温升高及恶性心律失常发生,3个月后治疗组左室舒张末期容积、左室收缩末期容积和代谢缺损犤(132.8±23.1)mL,(65.2±19.7)mL,(120.3±58.7)cm2犦明显高于或低于对照组犤(145.4±27.8)mL,(75.1±25.3)mL,(158.6±78.6)cm2犦(P<0.05)。两组患者射血分数值比较,差异无显著性意义(P>0.05)。结论:AMI患者自体MSCs冠状动脉内注射安全有效,可以改善患者心功能及预后,骨髓来源的心肌细胞生成及血管新生可能为其机制。
Objective: To study the safety and efficacy of intracoronary injection of autologous bone marrow mesenchymal stem cells (MSCs) in patients with acute myocardial infarction (AMI) and its possible mechanism. Methods: Ten patients with acute myocardial infarction (intervention group) underwent percutaneous coronary intervention (PCI) after operation, bone marrow separation, culture, 12 ~ 14d after intracoronary injection, select 10 cases of postoperative PCI refused to cell therapy Of the AMI patients as control group, 1 week and 3 months after PCI were followed up, echocardiography and 18 Fluoro-deoxy glucose single photon myocardial imaging. Results: No increase of temperature and malignant arrhythmia were found in the treatment group. After 3 months, the volume of left ventricular end-diastolic volume, the volume of left ventricular end-systole and the metabolic deficit 犤 (132.8 ± 23.1) mL, (65.2 ± 19.7) mL and (120.3 ± 58.7) cm2 犦 (145.4 ± 27.8) mL, (75.1 ± 25.3) mL and (158.6 ± 78.6) cm2 犦 (P <0.05) respectively. There was no significant difference in ejection fraction between two groups (P> 0.05). Conclusions: The intracoronary injection of autologous MSCs in patients with AMI is safe and effective, which can improve the cardiac function and prognosis of patients with AMI. The production of bone marrow-derived cardiomyocytes and angiogenesis may be its mechanism.