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目的了解心肌梗死(MI)患者行冠状动脉内支架置入术(percutaneous coronary intervention,PCI)后进行骨髓干细胞移植治疗的临床疗效。方法研究对象为2003年5月~2005年12月住院的MI患者246例,其中PCI后进行骨髓干细胞移植治疗者48(男44,女4)例,年龄29~74(58±9)岁。随机选择年龄相匹配,PCI后未经骨髓干细胞移植治疗的MI者198(男178,女20)例,年龄25~70(58±9)岁。采用Judkins方法经股动脉行冠状动脉造影和左室造影。全部病例均经心脏超声检查及随访,其中96例经冠状动脉造影随访(随访率39%),随访时间1~30(9.6±6)个月。造影证实原支架内血管直径狭窄≥50%,定为支架内再狭窄。48例PCI后进行骨髓干细胞移植治疗者在冠状动脉造影术前2 h,局麻下选择髂后上棘穿刺抽取骨髓液40~80 ml,分离骨髓单个核细胞备用。所有患者入院后详细记录病史,体格检查,于次日晨空腹取肘静脉血检查血脂(标准酶法)、血浆纤维蛋白原(凝血酶法)水平和肝、肾功能等。结果PCI后进行骨髓干细胞移植治疗组与单纯PCI治疗组相比:年龄、性别、吸烟、高血压病、糖尿病、血脂和纤维蛋白原水平,以及冠脉血管病变支数均无显著差异;PCI后进行骨髓干细胞移植治疗组支架再狭窄发生率低(P<0.01);两组治疗前后射血分数值改善情况均有显著统计学差异(P<0.01)。结论PCI后进行骨髓干细胞移植治疗MI可以降低支架再狭窄率,改善心功能。
Objective To investigate the clinical efficacy of bone marrow stem cell transplantation in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI). Methods A total of 246 MI patients admitted to hospital from May 2003 to December 2005 were enrolled in this study. 48 (44 males and 4 females) patients underwent bone marrow stem cell transplantation after PCI, ranging in age from 29 to 74 (58 ± 9) years. A randomized cohort of 198 patients (178 males and 20 females) with age matched and matched for PCI without bone marrow stem cell transplantation was aged 25-70 years (58 ± 9 years). The Judkins method was used to perform coronary angiography and left ventricular angiography through the femoral artery. All patients underwent echocardiographic examination and follow-up. Among them, 96 cases were followed up by coronary angiography (follow-up rate was 39%) and followed up for 1-30 (9.6 ± 6) months. Angiography confirmed the stent within the vessel diameter stenosis ≥ 50%, as a stent restenosis. 48 cases of bone marrow stem cell transplantation after PCI in patients 2 h before coronary angiography, under local anesthesia select the posterior superior iliac spine to extract bone marrow fluid 40 ~ 80 ml, bone marrow mononuclear cells were isolated. All patients were admitted to hospital after a detailed history, physical examination, fasting elbow venous blood taken the next day to check the blood lipid (standard enzyme method), plasma fibrinogen (thrombin) level and liver and kidney function. Results There was no significant difference in age, gender, smoking, hypertension, diabetes, serum lipids, fibrinogen, and coronary artery lesions between PCI group and PCI group after PCI The incidence of stent restenosis was significantly lower in the bone marrow stem cell transplantation group than in the control group (P <0.01). The improvement of ejection fraction before and after treatment was statistically significant (P <0.01). Conclusion Treatment of MI with bone marrow stem cells after PCI can reduce the rate of stent restenosis and improve cardiac function.