自体骨髓间充质干细胞移植治疗急性心肌梗死临床观察

目的探讨自体骨髓间充质干细胞经冠状动脉途径移植治疗急性心肌梗死的临床疗效。方法 NYHA心功能Ⅱ～Ⅳ级且心肌存在灌注缺损、拟择期行介入治疗术的急性心肌梗死患者36例,随机分为观察组17例和对照组19例,2组介入治疗术后分别通过大腔导管于梗死相关血管内注入等量骨髓间充质干细胞和生理盐水;于介入治疗术前、术后1,3个月行24h动态心电图、静息心脏超声心动图及99mTeSPECT检查进行疗效及风险评价。结果观察组左心室舒张末期内径术后3个月时较术前和术后1个月时均明显减小（P〈0.05）,对照组手术前、后差异无统计学意义（P〉0.05）;观察组左心室射血分数术后1,3个月时均较术前和同期对照组明显增加（P〈0.05）,对照组术后3个月较术前明显增大（P〈0.05）;观察组灌注缺损面积百分比术后3个月时较术前和术后1个月时均明显减小（P〈0.05）,对照组术后3个月与术前比较差异有统计学意义（P〈0.05）;术后3个月2组左心室舒张末期内径、左心室射血分数及灌注缺损面积百分比比较差异均有统计学意义（P〈0.05）;2组恶性临床事件比较差异无统计学意义（P〉0.05）。结论自体骨髓间充质干细胞移植治疗急性心肌梗死是相对有效安全的。

Autologous bone marrow mesenchymal stem cells transplantation for acute myocardial infarction

Objective To explore the clinical effect in coronary transplantation of bone marrow mesenchymal stem cells（MSCs） for acute myocardial infarction（AMI）.Methods Thirty-six AMI patients with NYHA classes Ⅱ to Ⅳ and myocardial perfusion defects,who underwent elective percutaneous coronary intervention（PCI）,were randomly divided into observation group（n=17） and control group（n=19）.Normal saline and MSCs in the same volume were infused into the infarct related artery via the guiding catheter after PCI in the control group and the observation group respectively.The effect and risk were assessed with 24-hour dynamic electrocardiography,resting echocardiography and 99mTeSPECT before PCI,one month after PCI and three months after PCI respectively.Results Left ventricular end-diastolic diameter（LVEDd） was significantly shorter three months after PCI than that before PCI and one month after PCI in the observation group（P0.05）,and there was no significant difference between before and after PCI in the control group（P0.05）.Left ventricular ejection fraction（LVEF） was obviously higher one month and three months after PCI than that before PCI in the observation group（P0.05） and than that at the same period in the control group（P0.05）.Perfusion defect area percentage was lower three months after PCI than that before PCI and one month after PCI in the observation group（P0.05）,and than that before PCI in the control group（P0.05）.There were significant differences in LVEDd,LVEF and perfusion defect area percentage three months after PCI between two groups（P0.05）.There was no significant difference in malignant clinical events between two groups（P0.05）.Conclusion Autologous bone marrow mesenchymal stem cells transplantation is safe and feasible for acute myocardial infarction.