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目的观察自体骨髓间充质干细胞经冠状动脉移植治疗扩张型心肌病的临床疗效。方法 38例NYHA心功能Ⅱ～Ⅳ级、心肌存在灌注缺损且左心室射血分数<40%的扩张型心肌病患者随机分为观察组18例和对照组20例,均通过冠脉动脉造影于冠状动脉内分别注入等量骨髓间充质干细胞和生理盐水。随访3个月并记录不同时期左心室射血分数、左心室舒张末期内径和心肌灌注缺损面积等指标,并通过24hHolter方法记录恶性心血管事件的发生。结果观察组术后1,3个月左心室射血分数均较术前及同期对照组明显增加(P<0.05),对照组术后3个月较术前明显增加(P<0.05);术后1个月观察组左心室舒张末期内径较术前减小(P<0.05),对照组较术前增加(P<0.05),2组差异有统计学意义(P<0.05);术后3个月时观察组左心室舒张末期内径较术前及术后1个月时均明显减少(P<0.05),对照组较术前增加(P<0.05),与1个月时比较差异无统计学意义(P>0.05),2组差异无统计学意义(P>0.05);术后3个月观察组灌注缺损面积百分比较术前及术后1个月时降低(P<0.05),对照组较术前降低(P<0.05);2组恶性临床事件差异无统计学意义(P>0.05)。结论自体骨髓间充质干细胞移植治疗扩张型心肌病安全、有效。
Objective To observe the clinical effect of autologous bone marrow mesenchymal stem cells transcatheter transplantation for dilated cardiomyopathy. Methods Thirty-eight patients with NYHA functional class Ⅱ ~ Ⅳ, patients with myocardial perfusion defect and left ventricular ejection fraction <40% were randomly divided into observation group (18 cases) and control group (20 cases) Coronary artery were injected with equal amounts of bone marrow mesenchymal stem cells and saline. The patients were followed up for 3 months and the indexes of left ventricular ejection fraction, left ventricular end-diastolic diameter and area of myocardial perfusion defect at different periods were recorded. The occurrence of malignant cardiovascular events was recorded by 24h Holter method. Results The left ventricular ejection fraction at 1 and 3 months postoperatively in the observation group was significantly higher than that before operation and in the same period (P <0.05), while in the control group at 3 months postoperatively, the ejection fraction was significantly increased (P <0.05) The left ventricular end-diastolic diameter in the observation group after 1 month was lower than that before the operation (P <0.05), and the control group increased compared with that before operation (P <0.05). The difference between the two groups was statistically significant (P <0.05) The end-diastolic diameter of the left ventricle in the observation group decreased significantly (P <0.05) compared with preoperative and postoperative month 1 months (P <0.05), and no significant difference compared with that at 1 month (P> 0.05). There was no significant difference between the two groups (P> 0.05). The percentage of perfusion defects in the observation group at 3 months after operation was lower than that before operation and one month after operation (P <0.05) (P <0.05). There was no significant difference in malignant clinical events between the two groups (P> 0.05). Conclusion Autologous bone marrow mesenchymal stem cell transplantation is safe and effective in treating dilated cardiomyopathy.