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目的研究自体骨髓干细胞经冠脉移植对心肌梗死患者心功能的影响及其安全性。方法24例冠心病伴心肌梗死患者,男20例,女4例,平均60岁(27～79岁),体外分离培养自体骨髓干细胞2～3周,开通梗死相关罪犯血管,通过冠脉转运将骨髓干细胞植入患者的心肌梗死区,移植的骨髓间充质干细胞数为(0.9～3.5)×106,骨髓单个核细胞数为(1.6～8.3)×106。术前和术后6个月分别行99mTcMIBI心肌灌注显像、二维超声心动图和动态心电图检查。结果2例患者因罪犯血管狭窄小于50%未行PCI,仅移植干细胞,1例患者因严重的冠状动脉三支血管病变未能行PCI而仅行干细胞移植,另l例患者行PCI术后,心功能仍无明显改善,半年后移植干细胞。其余20例患者在梗死相关动脉开通后注入细胞。24例患者二维超声心动图检查示LVEF较术前明显增加[51.13±9.68)vs.(42.58±12.49),P<0.05],LVDd较术前稍减少[(58.21±7.75)vs。(58.25±8.31),P>0.05],但未达统计学意义;16例99mTcMIBI检查显示梗死部位心肌灌流明显改善。术中及术后随访6～23个月无心律失常和其他合并症发生。结论进行自体骨髓干细胞经冠脉移植治疗冠心病、心肌梗死具有抑制左室重构,改善心脏功能的作用。随访6～23个月未见心律失常。
Objective To study the effect and safety of autologous bone marrow stem cells transplanted by coronary artery on cardiac function in patients with myocardial infarction. Methods 24 patients with coronary heart disease and myocardial infarction, 20 males and 4 females, with an average age of 60 years (27-79 years old), were cultured in vitro for 2 to 3 weeks. Autologous bone marrow stem cells were obtained for 2 to 3 weeks. Infarct- Bone marrow stem cells were implanted in patients with myocardial infarction. The number of transplanted bone marrow mesenchymal stem cells was (0.9 ~ 3.5) × 106, and the number of bone marrow mononuclear cells was (1.6 ~ 8.3) × 106. Preoperative and postoperative 6 months were 99mTcMIBI myocardial perfusion imaging, two-dimensional echocardiography and Holter monitoring. Results In 2 patients, only stem cells were transplanted due to less than 50% of vascular stenosis. Only 1 patient underwent coronary artery bypass grafting because of severe coronary artery disease. In the other 1 patient undergoing PCI, Heart function still no significant improvement, six months after transplantation of stem cells. The remaining 20 patients were infused into the cells after the infarct-related artery was opened. Two-dimensional echocardiography in 24 patients showed a significant increase in LVEF compared with preoperative [51.13 ± 9.68 vs. 42.58 ± 12.49, P <0.05], and a slight decrease in LVDd compared with preoperative [(58.21 ± 7.75) vs. (58.25 ± 8.31), P> 0.05], but did not reach statistical significance; 16 cases of 99mTcMIBI examination showed myocardial infarction significantly improved perfusion. Intraoperative and postoperative follow-up of 6 to 23 months without arrhythmia and other complications occurred. Conclusions Autologous bone marrow stem cells can be used to treat coronary heart disease by coronary artery transplantation. Myocardial infarction can inhibit left ventricular remodeling and improve cardiac function. Follow-up 6 to 23 months no arrhythmia.