自体骨髓间充质干细胞对肝硬化患者门静脉高压血流动力学的影响

目的观察白体骨髓间充质干细胞对乙型肝炎肝硬化失代偿患者门静脉血流动力学的影响。方法将2011年02月-2012年01月收治的乙型肝炎肝硬化失代偿住院患者46例配对分为两组。治疗组23例，对照组23例。两组患者在性别、年龄、诊断、生化及影像学指标方面差异无统计学意义。所有患者在签定知情同意书后进行治疗。对照组仅给予抗病毒及护肝利尿支持等治疗。治疗组抽取自体骨髓200ml，体外分离纯化骨髓间充质干细胞在体外诱导培养后制成10ml细胞悬液，经肝动脉注入肝脏，分别在治疗后第8、12周观察患者的门静脉血流动力学指标的变化。组内比较采用配对t检验，组间比较采用成组t检验。结果经骨髓间充质干细胞治疗8周和12周，治疗组门静脉内径（DPV）和脾静脉内径（DSV）下降，DPV在8周和12周分别为（13．26±1．3l）和（12．83±1．38）mm，与治疗前比较，t值为2．290和3．421，P〈0．05和P〈0．01；DSV在8周和12周分别为（8．39±1．38）和（8．02±1．24）mm，与治疗前比较，t值为2．079和2．787，P〈0．05和P〈0．01。与同期对照组比较，DPV在8周和12周t值为2．382和2．602，P值均〈0．05；DSV在8周和12周t值为3．236和4．185，P值均〈0．01，差异均有统计学意义。门静脉最大血流速度（PVX）增快，8周和12周分别为（20．72±4．63）和（20．58±3．46）cm／s，与治疗前比较，t值为2．833和3．198，P值均〈0．01，差异有统计学意义。与同期对照组（17．12±4．78）和（17．20±3．87）cm／s比较，差异有统计学意义（t值为2．530和3．123，P〈0．05和P〈0．01）。结论自体骨髓间充质干细胞可以明显改善乙型肝炎肝硬化失代偿患者的门静脉血流动力学指标。

Effect of autologous bone marrow -derived mesenchymal stem cells on portal hemodynamics in patients with liver cirrhosis

Objective To observe the effect of autologous bone marrow - derived mesenchymal stem ceils （BMMSCs） on the portal hemody- namics in patients with hepatitis B virus （HBV） -related decompensated cirrhosis. Methods Forty -six patients with HBV -related deeom- pensated cirrhosis, who were admitted to the hospital from February 2011 to January 2012, were divided into treatment group （n = 23） and control group （ n = 23 ）. There were no significant differences in sex, age, diagnosis, biochemical parameters, and imaging findings between the two groups. All patients provided informed consent prior to treatment. Both groups received antiviral, liver - protecting, and diuretic treatment. In addition, in the treatment group, bone marrow （200 ml） was drawn from each patient, BMMSCs were isolated, purified, anti cultured, and the cultured cells were processed into cell suspension （ 10 ml） ; the cell suspension was injected into the liver via the hepatic artery. After 8 and 12 weeks of treatment, the changes in portal hemodynamic parameters were evaluated. The obtained data were analyzed using SPSS 13.0 software ; the paired t test was used for within - group comparisons. Results After 8 and 12 weeks of treatment, in the treatment group, the diameter of portal vein （DPV） was significantly decreased to 13.26 ± 1.31 mm（ t = 2. 290, P 〈 0.05 ） and 12.83 ± 1.38 mm（ t = 3. 421, P 〈 0.01 ）, and the diameter of splenic vein （DSV） was significantly decreased to 8.39 ＋ 1.38 mm （t = 2. 079, P 〈 0.05 ） and 8.02 ± 1.24 mm （ t = 2. 787, P 〈 0.01 ） ; compared with the control group, the treatment group had significantly lower DPV （ t = 2.382, P〈0.05; t =2. 602, P〈0.05） and DSV （t =3.236, P〈0.01; t=4. 185, P〈0.01）. After 8 and 12 weeks otreatmenl, in the treatnlent group, the portal vein maximum velocity （PVX） was significantly increased to 20. 72 ± 4. 63 cm/s （t = 2. 833, P 〈 0.01 ） and 20.58 ＋ 3.46 cm/s （ t = 3. 198, P 〈0. 01） ; compared with the control group, the treatment group had significantly higher PVX （ t = 2. 530, P 〈0. 05; t = 3. 123, P 〈 0.01 ）. Conclusion Autologous BMMSCs can significantly improve the portal hemodynamics in patients with HBV -related decompensated cirrhosis.