经冠状动脉骨髓单个核细胞移植治疗缺血性心脏病二年随访

目的观察经冠状动脉自体骨髓单个核细胞（BMMC）移植治疗缺血性心脏病的长期效果及安全性。方法76例缺血性心脏病病人。其中BMMC移植者52例,包括急性心肌梗死（AMI）26例,慢性缺血性心力衰竭（CIHF）26例,对照24例（AMI10例,CIHF14例）。对照组：常规治疗（药物及介入治疗）;移植组：在常规治疗基础上加经冠状动脉自体BMMC移植。细胞移植方法：于髂后上嵴抽取骨髓,梯度密度法分离获得BMMC,将细胞悬液调为2×10^6/ml浓度,超选择性经梗死相关冠状动脉气囊充盈下高压注入BMMC,重复注入6—8次,或经冠状动脉选择性移植,气囊未充盈下高压注入移植细胞。随访观察临床及实验室指标,二维超声心动图,正电子发射体层心肌显象。结果52例完成2年随访。AMI病人BMMC移植后1年左室射血分数（LVEF）比术前增加了5．8％（53．9％±2．9％vs59．7％±1．5％,P〈0．05）,2年增加了3．8％（57．7％±1．7％,P〉0．05）,对照组LVEF减低,但差异无统计学意义。左室舒张末容量（LVEDV）、左室收缩末容量（LVESV）无显著改善。移植组2年心肌代谢缺损区与3个月比较无变化;BMMC移植组与术前相比差异有统计学意义（P〈0．05）。CIHF病人BMMC移植后1年、2年LVEF与术前比较分别增加了8．8％、9．2％（P〈0．01）,LVESV下降20．4％、27．8％（均P〈0．05）,2年心肌代谢缺损区与3个月比较无变化;对照组心功能明显恶化。Holter检测未发现新的心律失常。结论BMMC治疗可明显改善CIHF病人的心功能。而对AMI病人并无左室收缩功能改善的长期效果,仅限制了心室重塑。

Autologous mononuclear bone marrow cell transplantation by intracoronary route for patients with ischemic heart disease: observation of 2-years follow-up

OBJECTIVE: To investigate the long-term effect and safety of intracoronary autologous bone marrow mononuclear cell (BMMC) transplantation in patients with ischemic heart disease (IHD). METHODS: Seventy-six patients with IHD, 26 patients with acute myocardial infarction (AMI) and 26 patients with chronic ischemic heart failure (CIHF), underwent routine treatment plus intracoronary autologous BMMC transplantation, and 24 patients, including 10 patients with AMI and 14 patients with CIHF underwent routine treatment as controls. Autologous BMMC transplantation was performed via a balloon catheter placed into the infarct-related artery during balloon dilatation by high pressure infusion to occlude the artery, which was performed 6 - 8 times for 2 minutes each with 2-minute interval or via a balloon catheter without occluding the infarct-related artery. Follow-up was conducted for 2 years. RESULTS: The surgery was safety without major periprocedural complications. There were no other new arrhythmias found by Holter recorder during the 2-years follow-up. In the AMI patients receiving BNNC transplantation, the left ventricular ejection fraction (LVEF) 1 and 2 years later increased by 5.79% (P < 0.05), 3.79% (P > 0.05) respectively; but there was no change in left ventricular end diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV). The LVEF 1 and 2 years later of the control group increased by 8.8% and 9.2% respectively (both P < 0.01) and the LVESV 1 and 2 years later decreased by 20.4% and 27.8% respectively (both P < 0.05), the myocardium defect area 2 years later was not significantly different from that 3 months later. The heart function of the control group became markedly worse. CONCLUSION: Autologus BMMC intracoronary transplantation is safe and effective, especially in patients with CIHF.