自体骨髓干细胞移植治疗肝硬化失代偿期19例临床分析

目的 观察经肝动脉行自体骨髓干细胞移植对肝硬化失代偿期患者的治疗效果.方法 选择肝硬化失代偿期患者19例,在常规治疗的前提下抽取骨髓200 ml,在体外分离纯化骨髓干细胞并制成10 ml细胞悬液,经肝动脉将上述10 ml细胞悬液通过介入方法移植入肝脏,分别在移植后第2、4、8周复查肝脏功能,观察实验室指标、临床症状及不良反应情况.结果 移植后第4周,血浆白蛋白由（32.9±4.3）g/L升至（35.6±3.2）g/L（P〈0.05）,谷草转氨酶（AST）由（74.3±20.3）U/L降至（48.3±13.8）U/L（P〈0.05）,谷丙转氨酶（ALT）和总胆红素水平在移植前后无显著性变化,凝血酶原时间由术前的（23.7±4.8）s降至（19.3±3.1）s（P〈0.05）,甲胎蛋白由术前的（12.5±5.6）μg/L升至（24.7±9.7）μg/L（P〈0.05）;患者食欲改善,体力好转18例（94.7%）,腹胀减轻7例,腹水减少7例,胸水减少3例,下肢浮肿减轻5例.在全部19例患者中术中未发生严重并发症,患者近期无不良反应出现.结论 自体骨髓干细胞移植治疗可使失代偿期肝硬化患者肝功能明显改善,治疗安全有效且副作用小,可作为中晚期肝硬化患者的临床治疗手段之一.

Transplantation of autologous bone marrow stem cells via hepatic artery for 19 patients with decompensated cirrhosis

Objective To explore the effect of autologous bone marrow stem cell transplantation via hepatic artery in treatment of decompensated cirrhosis. Methods Nineteen patients with decompensated liver cirrhosis were selected for the trail. Beside the conventional treatment, a total of 200ml bone marrow was collected from posterior superior iliac spine of each patient. After isolation and purification, the stem cells were transplanted into the liver via hepatic artery. The clinical manifestations and laboratory data were collected in the second, fourth, and eighth week posttransplant. Results Four weeks after transplantation, the serum albumin concentration increased from （ 32.9 ± 4.3 ） g/L to （ 35.6 ±3.2 ） g/L （ P 〈 0.05 ）. AST decreased from（74.3 ±20.3 ） U/L to （48.3 ±13.8 ） U/L （ P 〈 0.05 ）. Prothrombin time decreased from （23.7 ±4.8） seconds to （ 19.3 ±3.1 ） seconds （P 〈 0.05 ）. AFP increased from （ 12.5 ±5.6）μg/L to （24.7 ±9.7）μg/L（P 〈0.05）. ALT and total bilirubin level was decreased,hut the the difference was not significant. Eight weeks after transplantation, appetite improved in 6 patients, ascites decreased in 7 patients, and abdominal distention alleviated in 7 patients, pleural effusion decreased in 3 patients ,lower extremity edema alleviated in 5 patients. There was no severe side effect in all the 19 patients during the survey phase. Conclusion After autologous bone marrow transplantation, the liver function and complications of patients were significantly improved. It was a safe and effective method and could be one of clinical treatment of patients with decompensated liver cirrhosis.