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目的:研究自体骨髓间充质干细胞(BMSCs)和单个核细胞(BMMNCs)经梗死相关冠状动脉(冠脉)移植对冠心病、心肌梗死患者近、中期心功能、心肌存活的影响及其安全性。方法:本项前瞻性、非随机、对照研究入选14例冠心病伴心肌梗死患者(其中8例患者为细胞治疗组,6例为常规治疗组)。细胞移植组患者,通过冠脉转运将BMSCs和BMMNCs植入心肌梗死区。两组患者均于术前和术后3、8个月分别行双核素SPECT心肌显像、二维超声心动图、6min步行试验及动态心电图检查。结果:移植组患者在梗死相关冠脉开通后注入干细胞,8例心功能从Ⅱ～Ⅳ级提高至Ⅰ～Ⅱ级,6min步行试验从320.72±60.47m提高至(406.88±68.31)m,6个月后又提高至(484.79±81.00)m。6例前壁心梗患者3、8个月后LVEF由术前的42.5%提高至49.5%和54.0%;心肌双核素检查缺损区占整个心肌体积术后3、8个月由术前的45.5%减少至39.0%和25.0%。6例对照组患者术后3个月EF较术前提高,心肌双核素检查缺损区占心肌体积减少,术后8个月与术后3个月无明显改变。2例下壁心肌梗死患者经干细胞移植临床效果不明显。结论:自体BMSCs和MMNCs经冠脉移植治疗冠心病心肌梗死,可以显著改善前壁心肌梗死患者左室收缩功能和心肌代谢,移植术后8个月仍能观察到重建心肌效应。
AIM: To investigate the effects of autologous bone marrow mesenchymal stem cells (BMSCs) and mononuclear cells (BMMNCs) on myocardial proximal and / or mid-cardiac function and myocardial viability after infarction-related coronary artery (coronary artery) transplantation and their safety . METHODS: This prospective, nonrandomized, controlled study was enrolled in 14 patients with coronary heart disease and myocardial infarction (8 patients were treated with cells and 6 patients were treated with conventional therapy). In the cell transplantation group, BMSCs and BMMNCs were implanted into the infarcted area by coronary artery transport. Two groups of patients underwent both radionuclide SPECT myocardial imaging, two-dimensional echocardiography, 6min walk test and ambulatory electrocardiogram before and 3,8 months after operation. Results: In the transplantation group, stem cells were infused after infarction-related coronary artery was opened. Heart function of 8 patients increased from Ⅱ ~ Ⅳ to Ⅰ ~ Ⅱ, and 6min walk test increased from 320.72 ± 60.47m to (406.88 ± 68.31) m, 6 Month and then increased to (484.79 ± 81.00) m. LVEF increased from 42.5% preoperatively to 49.5% and 54.0% in 6 patients with anterior myocardial infarction 3 and 8 months after operation. The myocardial infarct size accounted for the entire myocardial volume at 3 and 8 months postoperatively from 45.5 % To 39.0% and 25.0%. The 6-month-old control group had higher EF at 3 months after operation than that before operation. The myocardial infarct volume decreased with the use of dual-nuclide in the control group. There was no significant change at 8 months and 3 months after operation. Two patients with inferior myocardial infarction by stem cell transplantation clinical effect is not obvious. CONCLUSIONS: Autologous BMSCs and MMNCs can significantly improve left ventricular systolic function and myocardial metabolism after coronary artery transplantation in patients with coronary heart disease, and myocardial remodeling can still be observed at 8 months after transplantation.