自体骨髓干细胞移植治疗失代偿期肝硬化的护理体会

目的:探讨自体骨髓干细胞移植治疗失代偿期肝硬化的护理经验。方法:自体骨髓干细胞作为供体,在体外分离纯化后移植患者肝内,使损伤的肝功能得以恢复和重构,对20例患者实施有效的护理措施,增强了患者的自我保护能力,积极配合治疗。结果:20例患者未出现不良反应及并发症,围手术期成功率100%。结论:在自体骨髓干细胞移植治疗失代偿期肝硬化过程中,护士的充分准备、医护患间的良好沟通与配合以及健康教育和指导是自体骨髓干细胞移植得以顺利进行的重要保证。     

自体骨髓移植治疗失代偿期肝硬化的临床观察

目的 研究自体骨髓经门静脉输注对失代偿期肝硬化的治疗作用。方法 回顾性分析2016年1月到2019年12月对失代偿期肝硬化患者做自体骨髓经门静脉输注的临床资料。其中30例进行常规药物保肝利尿等治疗,52例常规治疗+自体骨髓经门静脉输注,55例常规治疗+脾切除+自体骨髓经门静脉输注。结果 30例进行常规治疗后1个月和3个月与治疗前相比肝功能和血常规各项指标没有好转;2例死于消化道出血。52例常规治疗+门静脉自体骨髓输注治疗后1个月和3个月肝功能指标明显好于常规治疗（P＜0.05）;2例死于消化道出血。55例常规治疗+脾切除+自体骨髓经门静脉输注治疗后1和3个月肝功能指标明显好于常规治疗（P＜0.05）;3例手术后1周内死于创面出血诱发的肝衰竭。治疗3个月后,常规治疗+脾切除+自体骨髓经门静脉输注、常规治疗+自体骨髓经门静脉输注与常规治疗相比,在白细胞数[（6.28±1.63）×10⁹,（3.39±0.98）×10⁹,（3.04±0.65）×10⁹]、血红蛋白量[（107.16±19.25）g/L,（98.66±19.81）g/L,（92.54±17.52）g/L]、血小板数[（223.00±47.99）×10⁹,（45.52±12.93）×10⁹,（38.64±9.48）×10⁹]方面均明显增高（P＜0.05）。结论 常规治疗对失代偿期肝硬化没有明显疗效。常规治疗加自体骨髓经门静脉输注可以明显促进失代偿期肝硬化的肝功能重建,但是不能缓解脾功能亢进。脾切除加自体骨髓经门静脉输注可以解除脾功能亢进,并促进失代偿期肝硬化的肝功能重建,但是脾切除术后创面渗血容易诱发肝衰竭,有较高手术风险。对肝功能C级的失代偿期肝硬化可以先作上腹部小切口经网膜右静脉插管输注自体骨髓,待肝功能好转后,再做脾切除,可以降低手术风险。     

自体骨髓干细胞移植治疗失代偿期肝硬化

目的 探讨自体骨髓干细胞移植对失代偿期肝硬化患者的疗效.方法 回顾性分析2009年7月至2010年3月解放军第一○五医院收治的28例失代偿期肝硬化患者的临床资料.抽取患者骨髓后,体外分离、纯化骨髓间充质干细胞(BMSCs),经股动脉置管至肝固有动脉,再将BMSCs植入肝脏.自体移植后观察患者临床症状、体征,术前、术后第2、4、8、12周检测肝功能生化指标.组间比较采用单因素方差分析,当方差齐时,组间多重比较采用LSD法分析,若方差不齐则采用Dunnett's法.结果 本组中,26例患者术后1周食欲增加,乏力明显改善;23例术后第4周腹腔积液明显减少或消失.至第12周,患者ALT由(99±36)U/L降至(48±26)U/L,AST由(86±36)U/L降至(46±22)U/L,TBil由(38±16)μmol/L降至(18±13)μmol/L,Alb由(29±4)g/L升至(35±5)g/L,PT由(19±4)s降至(13±4)s.治疗前、后患者各实验室指标比较,差异有统计学意义(F=267.35,143.52,218.74,125.57,331.25,P<0.05).本组患者未见发热、皮疹、过敏反应等并发症,其中1例髂后上棘穿刺点出现血肿,1周后自行消退;1例在施行BMSCs移植过程中出现肝区不适,移植完毕拔管后症状消失;1例于术后3个月因上消化道大出血死亡.结论 BMSCs移植治疗失代偿期肝硬化近期安全有效,远期效果有待进一步观察.     

自体骨髓干细胞移植治疗失代偿期肝硬化

Objective To investigate the therapeutic effects of bone marrow stem cells for the treatment of decompensated liver cirrhosis. Methods The clinical data of 28 patients with decompensated liver cirrhosis who were admitted to the No. 105 Hospital of PLA from July 2009 to March 2010 were retrospectively analyzed. Bone mesenchymal stem cells (BMSCs) were separated and purified from the bone marrow cells of the patients in vitro,and then they were transplanted into the liver of the patients through proper hepatic artery. The clinical symptoms and physical signs of the patients were monitored, and the biochemical indexes of the liver were measured at the 2nd, 4th, 8th and 12th weeks after operation. All data were analyzed using the analysis of variance, LSD test or Dunnett's test. Results The appetite and physical strength of 26 patients were apparently improved one week after operation. The ascites of 23 patients were reduced at the end of the 4th week. At the end of the 12th week,the level of alanine aminotransferase was decreased from (99 ± 36)U/L to (48 ± 26 )U/L, aspartate aminotransferase was decreased from (86 ±36)U/L to (46 ±22)U/L, total bilirubin was decreased from (38 ± 16)μmol/L to (18 ± 13)μmol/L, albumin was increased from (29 ± 4)g/L to (35 ± 5 )g/L, and the prothrombin time was decreased from ( 19 ±4)s to ( 13±4) s. There were significant differences in the biochemical indexes of the liver after operation when compared to those before operation ( F =267. 35, 143. 52, 218. 74, 125. 57, 331.25, P <0.05). No fever, rash or allergic reaction was detected. Hematoma was detected in the incision site of the posterior superior iliac spine in one patient, and it disappeared one week later; one patient had discomfort in the liver area during the process of the BMSCs transplantation, and the discomfort disappeared at the end of the process; one patient died of hemorrhage of the upper gastrointestinal tract at the end of the 3rd month after operation. Conclusion The short term outcome of the autologous BMSCs transplantation for the treatment of decompensated liver cirrhosis is satisfactory, while its long term effect needs to be further investigated.     

自体骨髓对失代偿期肝硬化合并小肝癌的治疗

目的研究在自体骨髓经门静脉输注改善肝功能的基础上对失代偿期肝硬化合并小肝癌进行综合治疗。方法自2010年1月至2015年12月,上海市公共卫生临床中心对12例失代偿期肝硬化合并小肝癌患者,施行经网膜右静脉插管埋置输液港,做自体骨髓经输液港输注进入门静脉改善肝硬化,在肝功能改善后,进行介入栓塞治疗和射频治疗小肝癌。结果自体骨髓经输液港输注进入门静脉后肝功能有明显改善。白蛋白总体呈上升趋势,上升趋势通过简单线性回归计算得出有统计学意义(P0.0001);总胆红素变化没有统计学意义(P=0.50);凝血酶原时间缩短(P0.0001);肝功能评分呈现显著下降趋势(P0.0001)。介入栓塞和射频消融治疗后小肝癌病灶缩小或完全坏死纤维化。2例术后12个月内死于消化道出血,2例术后24个月内死于肝癌转移,其余8例均在肝功能大致正常状态下存活,最长随访时间已经超过6年。结论自体骨髓经门静脉输注后可以明显改善肝功能,然后作介入栓塞和射频消融控制小肝癌,食管下段曲张静脉内镜套扎治疗防止消化道出血,可以使失代偿期肝硬化合并小肝癌患者在肝功能恢复正常的状态下长期存活。     

经门静脉自体骨髓细胞回输治疗失代偿期肝硬化42例疗效分析

目的观察经门静脉自体骨髓细胞回输治疗失代偿期肝硬化患者的效果及安全性。方法回顾分析42例接受经门静脉输液港途径回输自体骨髓细胞治疗的失代偿期肝硬化患者的临床资料。比较患者术前、术后连续3个月血清丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、清蛋白(ALB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及临床症状、腹部体征改善情况。结果除1例患者术后因肝性脑病加重死亡外,其余患者自体骨髓细胞回输术后1个月及3个月的ALT、TBIL、ALB、PT、APTT均较术前改善,差异有统计学意义(P0.05)。自体骨髓细胞回输术后3个月,患者乏力好转30例,食欲改善32例,腹胀减轻29例,腹腔积液减少25例。未发现严重不良反应及并发症。结论经门静脉自体骨髓细胞回输治疗失代偿期肝硬化患者疗效确切、安全性好。     

失代偿肝硬化合并胆囊结石的自体骨髓肝内输注治疗

目的 研究自体骨髓经门静脉肝内输注对失代偿期肝硬化合并胆囊结石患者的疗效。方法 观察18 例失代偿期肝硬化合并胆囊结石患者,其中4 例采用单纯腹腔镜胆囊切除手术;14 例采用脾切除加自体骨髓经门静脉输注治疗。结果 4例单纯胆囊切除手术患者术中出血多,术后1年肝功能没有改善。14例脾切除加自体骨髓经门静脉输注治疗者,术后3个月肝功能基本恢复正常,其中4例脾切除手术时切除胆囊患者,术中出血多;3例1年后再次手术切除胆囊患者,手术顺利。7例患者没有切除胆囊,无明显临床症状。结论 自体骨髓经门静脉输注治疗可以促进失代偿期肝硬化患者肝功能重建,肝功能好转后再次手术胆囊切除可以降低手术风险     

自体骨髓干细胞移植治疗晚期肝硬化综述

干细胞是一类具有自我更新、增殖和多向分化能力的细胞,具有不对称分裂和无限增殖的特点,按来源可分为胚胎干细胞和成体干细胞.骨髓干细胞肝脏移植是将患者自体骨髓干细胞移植到其肝脏内,分化为有功能的实质细胞,以替代因退变、损伤、基因缺陷或自身免疫而受损的肝细胞,重构组织器官的结构和功能具体方法是从患者体内抽出少量骨髓,用先进的细胞分离技术分出移植所需的干细胞,通过介入把提取的干细胞注入病肝.目前,骨髓干细胞移植已具有较为完备的理论及实验基础,而自体骨髓移植、肝动脉插管介人治疗等均为临床上已经成熟的技术,因此在理论与技术方面均为干细胞肝脏移植提供了保障.我国是肝病尤其是病毒性肝炎的高发区,各种原因导致的肝硬化患者众多,在药物及原位肝移植治疗之外,自体骨髓源性干细胞移植治疗失代偿期肝硬化是一种全新而有效的新方法,其虽不能给肝病患者带来治愈性的效果,但可在很大程度上控制肝硬化的进展速度,提高肝硬化患者的生存质量.     

肝硬化失代偿期低钠血症相关因素分析及护理

目的 探讨肝硬化失代偿期发生低钠血症的相关因素及护理措施。方法 从护理的角度对96例肝硬化失代偿期低钠血症患者的临床资料进行由顾性分析。结果 96例肝硬化患者失代偿期低钠血症的诱发因素主要为摄入不足与排出过多、利尿剂使用不当、长期低钠饮食和多次放腹水。不同程度低钠血症患者肝性脑病、肝肾综合征的发生率及预后比较．差异有显著性意义（P〈0．05。P〈0．01）。结论 临床护理工作中需密切注意肝硬化失代偿期低钠血症的各项相关因素。根据不同原因进行心理护理和饮食指导．加强治疗中用药观察和护理．预防肝性脑病和肝肾综合征的发生。     

失代偿期肝硬化合并腹壁疝的治疗

腹壁疝修补手术是普外科中简单的小手术,但是如果患者处于失代偿期肝硬化,大量腹水合并腹壁疝,在这种情况下能够成功修补腹壁疝和防止复发,就相当困难.肝硬化低蛋白血症影响伤口愈合,大量腹水致腹内高压容易使疝复发,手术成功的关键是改善肝功能.我们对7例失代偿期肝硬化合并腹壁疝患者在做疝修补手术时顺便经网膜右静脉插管,在上腹部埋置皮下液体输注系统,做自体骨髓经门静脉输注,结果不但疝修补伤口愈合良好,而且肝功能明显改善,现介绍如下.     

Effect of autologous bone marrow derived mesenchymal stem cells in treatment of rheumatoid arthritis

IntroductionChronic inflammation causes articular bone and cartilage degeneration in people with rheumatoid arthritis (RA). Despite recent advancements in the management of RA, adverse side effects and ineffective treatments remain a problem. Effective treatment is usually hampered by financial issues. As a result, less expensive medications that reduce both inflammation and bone resorption are required. Mesenchymal stem cells (MSCs) have recently been identified as a potential therapy for RA.Aim of the studyThis study aimed to examine the anti-arthritic effect of rat bone marrow-derived mesenchymal stem cells (rBM-MSCs), oligosaccharides (Os), and human placental extract (HPE), individually and combined, on an RA model, using Complete Freund's adjuvant (CFA)-induced arthritis in rats.Materials and methodsIn female rats, RA was induced by injecting CFA in the paw of the hind limb. Rat bone marrow-MSCs, oligosaccharides, and human placental extract (HPE) were given individually and in combination via the intraperitoneal route. A complete blood count (CBC), erythrocyte sedimentation rate (ESR), serum cortisol, urea, uric acid, and other biochemical parameters were measured to determine the safety and efficacy of the different treatments. Histopathological analysis of bone sections was carried out.ResultsCombining oligosaccharides and HPE therapy with the infusion of rat-bone marrow MSCs had beneficial antiarthritic and anti-inflammatory effects in CFA-induced arthritis in rats: overall such triple therapy significantly reduced serum levels of IL-6, IL-10, and TNF-alpha in comparison with all other combinations (all P > 0.05). Meanwhile, the triple therapy did not have negative effects on levels of CBC, serum cortisol, ESR, and liver enzymes (all NS) as well as on renal functions (NS). Also, the histopathological analysis showed significant improvements in the healing and remodelling of osteoporotic lesions in arthritic rats. As shown by counting apoptotic cells as a histopathological substitute for measuring apoptotic or regeneration markers, the lowest count was found in the group treated with a triple therapy of rat bone marrow-derived mesenchymal stem cells (rBM-MSCs), oligosaccharides, and HPE.ConclusionThe combination of rat MSCs, oligosaccharides, and HPE has the potential to be an effective treatment for rheumatoid arthritis.     

骨髓间充质干细胞联合基因治疗肝纤维化的研究进展

骨髓间充质干细胞治疗肝纤维化的关键在于促进肝细胞再生和抑制肝组织纤维化,但目前单独应用骨髓间充质干细胞治疗肝纤维化的效果不明显,由于骨髓间充质干细胞是外源基因的良好载体,相关研究发现,通过体内、体外将促进肝细胞再生和抑制肝组织纤维化的基因转染骨髓间充质干细胞,可以加强骨髓间充质干细胞治疗肝纤维化的效果,这为肝纤维化的治疗带来新的策略。