经冠脉移植自体骨髓干细胞治疗扩张型心肌病的安全性及疗效

目的：探讨经冠状动脉自体骨髓干细胞移植治疗扩张型心肌病的安全性和疗效。方法：选择经超声、冠状动脉造影证实为扩张型心肌病患者52例，随机分为自体骨髓干细胞移植组（细胞移植组）和对照组，两组均予常规抗心力衰竭（心衰）药物治疗，细胞移植组自体骨髓干细胞经微导管注入左、右冠状动脉。两组术前，术后24h、48h，1、3和6个月分别检测血常规及生化指标（肝功能、肾功能、血糖、血脂、血尿酸、肌酸激酶、肌酸激酶同工酶和hs—CRP），术前，术后1、3和6个月分别行超声心动图、动态心电图、6min步行试验检查。结果：细胞移植组术后24h、48h，1、3和6个月血常规及生化指标与对照组和自身术前相比均无显著性差异（P〉0．05）。术后6个月，细胞移植组6min步行路程增加，与对照组有显著差异（P〈0．05），与术前有显著差异（P〈0．05），但超声心动图显示两组间左室舒张末容积和左室射血分数无统计学差异（P〉0．05）。围手术期及术后6个月随访中未见任何严重心律失常等不良反应发生。结论：经冠状动脉自体骨髓干细胞移植治疗扩张型心肌病安全、有效。

Effect and security of intracoronary transplantation of autologous bone marrow stem cells on patients with dilated cardiomyopathy

Objective:To explore the efficacy and safety of intracoronary autologous mesenchymal stem cells(MSCs) transplantation for treating patients with dilated cardiomyopathy(DCM).Methods:A total of 52 DCM patients received standard drug therapy were randomly divided into intracoronary injection of autologous MSCs group(27 cases) and saline group(control group,25 cases).The clinical characteristics of two groups were comparable.Blood routine test,hepatic function,renal function,glucose,triglyeride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),uric acid(UA),creatine kinase(CK),isoenzyme of creatine kinase(CK-MB) and high sensitive C-reactive protein(hsCRP) were measured at the time point of pre-operation and some time after transplantation.All patients were monitored under ultrasonic cardiography,Holter;and six-minute-walk test was performed over a period of at least 6 months.Results:Blood routine test,hepatic function,renal function,glucose,TG,cholesterol,LDL-C,HDL-C,UA,CK,CK-MB and hsCRP levels had no significant differences among 24h,48 h,3 months and 6 months after transplantation compared with control and pre-transplantation(P>0.05).Six-minute-walk distance elevated significantly six months after MSCs transplantation compared with control and pre-transplantation(P<0.05).Left ventricular ejection fraction and the sizes of LVEDd had no significant changes compared with that of control and pre-transplantation(P>0.05).No malignant arrhythmias and severe side effects could be observed around transplantation and during six months follow-up.Conclusion:Intracoronary autologous bone marrow stem cell transplantation is safe and effective.