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背景:目前关于干细胞移植的疗效与分化机制尚未达成共识,但大量临床研究结果均显示干细胞移植可以改善心脏功能。目的:探讨自体骨髓单个核细胞移植治疗慢性心力衰竭患者的效果。设计:病例分析。对象:河南省人民医院2003/2008收治的慢性心力衰竭患者80例,分为2组:骨髓细胞移植组48例,标准药物治疗组32例,2组患者在性别、年龄、接受标准药物治疗、移植前超声心动图、血浆脑钠肽和心肌灌注显像检测结果等基线资料方面比较无明显差异(P>0.05),具有可比性。方法:在细胞移植前和移植后1年随访期间,2组患者均根据临床需要给予标准的药物治疗。骨髓细胞移植组患者在标准药物治疗的基础上,将自体骨髓单个核细胞悬液10mL经造影导管缓慢注入冠状动脉内,细胞数(3.1±1.6)×108。主要观察指标:采用超声仪测定心功能指标的变化,通过双抗夹心免疫荧光法全定量测定血浆脑钠肽含量变化,应用单光子放射计算机断层显像术检测心肌灌注缺损区面积。结果:2组患者均完成1年随访,移植前后无不良反应和并发症发生。①与移植前比较,1年后骨髓细胞移植组左室收缩末容积明显降低(P<0.05),左室射血分数明显提高(P<0.05);标准药物治疗组此2项指标无明显变化(P>0.05)。与标准药物治疗组比较,1年后骨髓细胞移植组左室收缩末容积、左室射血分数均有明显改善(P<0.05)。②与移植前比较,2组患者血浆脑钠肽含量均明显降低(P<0.05或0.01),心肌灌注缺损面积均明显缩小(P<0.05或0.01),且骨髓细胞移植组变化幅度大于标准药物治疗组(P<0.05)。结论:自体骨髓单个核细胞移植治疗慢性心力衰竭安全可行,移植后1年内能明显改善心功能及心肌血流灌注情况。
BACKGROUND: At present, there is no consensus on the efficacy and differentiation mechanism of stem cell transplantation. However, a large number of clinical studies have shown that stem cell transplantation can improve cardiac function. Objective: To investigate the effect of autologous bone marrow mononuclear cell transplantation in patients with chronic heart failure. Design: Case Analysis. PARTICIPANTS: Eighty patients with chronic heart failure admitted to Henan Provincial People’s Hospital in 2003/2008 were divided into two groups: 48 patients in bone marrow transplantation group and 32 patients in standard medicine treatment group. The patients in two groups were divided into two groups according to gender, age, standard medical treatment, Pre-transplant echocardiography, plasma brain natriuretic peptide and myocardial perfusion imaging test results and other baseline data showed no significant difference (P> 0.05), comparable. Methods: Both before and 1 year after transplantation, patients in both groups were given standard medications according to clinical needs. Bone marrow cell transplantation group patients on the basis of standard medical treatment, the autologous bone marrow mononuclear cell suspension 10mL catheter slowly injected into the coronary artery, the number of cells (3.1 ± 1.6) × 108. MAIN OUTCOME MEASURES: Changes of cardiac function indexes were measured by ultrasound system. The content of plasma brain natriuretic peptide was quantified by double antibody sandwich immunofluorescence method. The area of myocardial perfusion defect area was detected by single photon emission computed tomography. Results: All patients in the two groups were followed up for 1 year. No adverse reactions and complications occurred before and after transplantation. ①Compared with that before transplantation, left ventricular end-systolic volume (P <0.05) and left ventricular ejection fraction (LVEF) increased significantly in bone marrow cell transplantation group after 1 year (P <0.05); there was no significant difference between two groups in standard medicine treatment group (P> 0.05). Compared with standard medicine treatment group, left ventricular end-systolic volume and left ventricular ejection fraction were significantly improved in bone marrow cell transplantation group after 1 year (P <0.05). ② Compared with those before transplantation, the content of plasma brain natriuretic peptide in both groups were significantly decreased (P <0.05 or 0.01), myocardial perfusion defect area was significantly reduced (P <0.05 or 0.01), and the change extent of bone marrow cell transplantation group was greater than that of standard medicine Treatment group (P <0.05). CONCLUSION: Autologous bone marrow mononuclear cells transplantation is safe and feasible for chronic heart failure. Cardiac function and myocardial perfusion can be significantly improved within 1 year after transplantation.