论文部分内容阅读
目的:探讨急性心肌梗死患者自体骨髓单个核细胞(BM-MNCs)经冠状动脉移植治疗对心功能的长期保护作用。方法:84例急性心肌梗死患者,急诊静脉溶栓或急诊介入治疗[经皮冠状动脉成形术(PTCA)加支架置入]后2周内行择期介入治疗。84例中50例作为细胞治疗组,抽取骨髓40ml,提取BM-MNCs,经冠状动脉注入;另34例作为对照组以同样方法注入20ml的0.9%氯化钠溶液。所有患者均于发病1～2周(平均9.5d)时(择期介入前)进行超声心动图检查和低剂量多巴酚丁胺超声心动图负荷试验,于发病6个月和1～5年时复查;并随访记录心血管事件发生率及病死率。结果:细胞治疗组患者5年临床随访心血管事件发生率及病死率均明显低于对照组,且心功能改善更加明显;6个月复查时,2组患者左室射血分数(LVEF)和室壁运动记分指数(WMSI)、左室舒张末容积指数(EDVI)、左室收缩末容积指数(ESVI)、心排血指数(CI)、每搏量指数(SI)等心功能指标均较术前有明显改善(P<0.01),但细胞治疗组WMSI、LVEF、ESVI、CI等指标及负荷状态下WMSI(△WMSI)、LVEF(△LVEF)均较对照组改善得更明显(P<0.01);5年超声心动图复查时,细胞治疗组EDVI、CI及LVEF较术前明显改善(P<0.01),并明显优于对照组(P<0.01)。结论:自体BM-MNCs治疗对梗死后心功能有长期保护作用。
Objective: To investigate the long-term protective effect of autologous bone marrow mononuclear cells (BM-MNCs) on cardiac function after coronary artery transplantation in patients with acute myocardial infarction. Methods: Eighty - four patients with acute myocardial infarction were treated with elective intravenous thrombolysis or emergency interventional therapy [percutaneous transluminal coronary angioplasty (PTCA) plus stent implantation] within 2 weeks after elective intervention. Fifty-four of 84 cases were used as cell therapy group, bone marrow was extracted from 40ml, BM-MNCs were extracted and injected into coronary artery. The other 34 cases as control group were injected with 20ml 0.9% sodium chloride solution in the same way. All patients underwent echocardiography and low-dose dobutamine stress echocardiography at 1-2 weeks (mean 9.5 days) (before elective intervention). At 6 months and 1-5 years Review; Follow-up recorded the incidence of cardiovascular events and mortality. Results: The 5-year clinical follow-up of patients in the cell therapy group was significantly lower than the control group in cardiovascular events and mortality, and the improvement of cardiac function was more obvious. At the 6-month follow-up, the left ventricular ejection fraction (LVEF) Wall function index (WMSI), left ventricular end-diastolic volume index (EDVI), left ventricular end systolic volume index (ESVI), cardiac output index (CI) and stroke volume index (SI) (P <0.01) .WMSI, LVEF, ESVI, CI and other indicators of WMSI, △ WMSI and △ LVEF in the cell treated group were significantly improved compared with the control group (P <0.01) ); 5-year echocardiographic review, cell treatment group EDVI, CI and LVEF significantly improved compared with preoperative (P <0.01), and significantly better than the control group (P <0.01). CONCLUSIONS: Autologous BM-MNCs have long-term protective effects on cardiac function after infarction.