自体骨髓单个核细胞移植治疗风湿性心脏病可行性研究

目的观察自体骨髓单个核细胞（BMMNCs）心肌内移植对风湿性心脏病患者心功能的影响,探讨其临床实用性。方法选取以左室扩大为主的风湿性心脏病患者5例,瓣膜置换手术当日采取髂骨骨髓20ml,同上法获得自体BMMNCs悬液备用。瓣膜置换完毕,于特定局部心肌内注入上述细胞悬液,分别于术前、术后1周及术后3个月行门控核素心血池显像（MGBP）检查,评价患者心功能及局部心肌舒缩能力,同时监测围手术期心电图及各项实验室指标。结果患者围手术期均未发现明显不良反应,术后3＋71反映左室收缩功能的各项指标显著升高,左室8个分区局部射血分数（rEF）亦明显升高,尤以S3～S6为著。结论自体BMMNCs心肌内移植方法简便、可靠,进一步的严格对照、多中心、随机双盲的大样本临床实验可以进行。     

自体骨髓单个核细胞移植治疗冠心病心力衰竭的临床研究

目的:评价经冠状动脉内注射自体骨髓单个核细胞治疗冠心病心力衰竭患者的有效性。方法:82例冠心病心力衰竭患者随机入选本项前瞻性、对照试验(其中49例患者为细胞移植组,33例为常规治疗组)。2组患者均接受标准药物治疗,细胞移植组49例患者同时接受自体骨髓单个核细胞移植。1年后随访临床情况及超声心动图、单光子放射计算机断层显像术和血浆脑钠肽测定结果,比较2组治疗前后心功能指标和心肌灌注缺损区面积。结果:细胞移植组与常规治疗组比较,左室射血分数增加,心肌灌注缺损面积降低,血浆脑钠肽下降,差异均有统计学意义(P<0.05)。结论:经皮冠状动脉内移植骨髓单个核细胞治疗冠心病心力衰竭,能有效改善左室收缩功能和心肌灌注。     

自体骨髓单个核细胞移植治疗肝硬化的临床评价

目的探讨肝动脉插管自体骨髓单个核细胞（BM—MNCs）移植治疗肝硬化的安全性、可行性及疗效。方法201例肝硬化患者,其中131例进行自体骨髓单个核细胞移植,70例作为对照组。骨穿采集自体骨髓体外分离纯化骨髓单个核细胞。经肝动脉插管将其移植入肝脏。分别于移植后4、8、12、24周观察血清白蛋白（ALB）、胆碱酯酶（CHE）、凝血酶原活动度（PTA）及总胆红素（TBil）变化情况,观察患者并发症及预后。结果移植组患者移植前血清ALB、CHE及PTA分别为29．33g／L、2387．4U／L和46．4％。移植后4周分别升至32．37g／L、2875．9U／L和53．54％,12周分别为32．95g／L、3190．6U／L和57．24％,24周则分别为32．22g／L、3066．5U／L和56．02％。患者移植后24、周内血清ALB、CHE和PTA水平较治疗前均显著升高,而对照组则无明显升高,两组比较差异有统计学意义。而血清TBil在移植后24周内改善情况与对照组相比差异无统计学意义。两组患者24周内主要并发症发生率及预后情况差异无统计学意义。移植后无严重不良事件发生。结论自体骨髓单个核细胞移植能改善肝硬化患者肝脏合成能力,并有良好的安全性。     

骨髓单个核细胞移植治疗缺血性心脏病临床研究的现状

骨髓单个核细胞(BMMNCs)是由多种细胞组成的混合细胞群,主要包括间充质干细胞、内皮祖细胞和造血干细胞。目前,大量的临床试验都表明自体BMMNCs经冠状动脉或心内膜等途径移植可分化为心肌细胞、内皮细胞和平滑肌细胞,从而修复再生心肌细胞,改善心功能,为缺血性心脏病提供新的治疗途径。本文就目前自体BMMNCs移植治疗缺血性心脏病的临床试验进行综述。     

自体骨髓单个核细胞移植治疗扩张型心肌病的临床研究

目的研究自体骨髓单个核细胞(ABMMNCs)经冠状动脉(冠脉)移植对扩张型心肌病(DCM)患者心功能的影响及其安全性。方法16例扩张型心肌病患者,按患者的意愿分成两组移植组(n=10)在药物治疗的同时,通过冠脉转运将ABMMNCs移植入心肌组织内;对照组(n=6)只进行相关的药物治疗;两组在术前和术后6个月分别行超声心动图及动态心电图检查。结果超声心动图检查显示移植组的左心室射血分数(LVEF)较术前明显增高,左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVSd)较术前明显降低,左心房内径(LAD)也较术前明显降低。而对照组的LVEF,LVDd及LVSd虽然较6个月前有所改善,但差异无统计学意义(P>0.05)。术中及术后随访6~12个月均无恶性心律失常和其他合并症发生。结论ABMMNCs经冠脉移植,可以治疗扩张型心肌病,改善心脏功能,而且较为安全。     

自体骨髓单个核细胞移植治疗脑出血近期临床疗效及对神经功能恢复的影响

目的探讨自体骨髓单个核细胞(MNCs)移植治疗脑出血的近期临床疗效及对神经功能恢复的影响。方法选择33例急性脑出血患者予钻孔引流术,术后留置引流管,当血肿引流基本干净、拔除引流管前经管注入自体MNCs悬液体3.0 ml。选择同期年、性别及病情严重程度相似但未行自体MNCs移植治疗的急性脑出血患者66例作为对照组,分别与术前、术后第1天、1、2、4、8、12 w,比较两组患者美国国立卫生研究院卒中量表(NIHSS评分)、日常活动能力评分(Barthel评分)。同时应用致残量表(mRS)比较两组患者治疗前及治疗后12 w临床疗效有无差别。结果治疗后两组患者NIHSS评分于2 w后开始下降,至8 w与12 w时试验组分值明显低于对照组(P<0.05);Barthel评分于2 w后开始上升,至12 w时试验组分值明显高于对照组(P<0.05);根据mRS量表,试验组治疗后总有效率为72.7%,显著高于对照组46.8%(P<0.05)。治疗随访期间试验组死亡4例,对照组死亡9例,死亡风险无差别(P>0.05)。结论自体MNCs移植治疗脑出血近期临床疗效显著,有利于神经功能恢复。     

冠状动脉内自体骨髓单个核细胞移植治疗急性心肌梗死患者的长期疗效观察

目的:探讨急性心肌梗死患者自体骨髓单个核细胞(BM-MNCs)经冠状动脉移植治疗对心功能的长期保护作用.方法:84例急性心肌梗死患者,急诊静脉溶栓或急诊介入治疗[经皮冠状动脉成形术(PTCA)加支架置入]后2周内行择期介入治疗.84例中50例作为细胞治疗组,抽取骨髓40 ml, 提取BM-MNCs,经冠状动脉注入;另34例作为对照组以同样方法注入20 ml的0.9%氯化钠溶液.所有患者均于发病1～2周(平均9.5 d)时(择期介入前)进行超声心动图检查和低剂量多巴酚丁胺超声心动图负荷试验,于发病6个月和1～5年时复查;并随访记录心血管事件发生率及病死率.结果:细胞治疗组患者5年临床随访心血管事件发生率及病死率均明显低于对照组,且心功能改善更加明显; 6个月复查时,2组患者左室射血分数(LVEF)和室壁运动记分指数(WMSI)、左室舒张末容积指数(EDVI)、左室收缩末容积指数(ESVI)、心排血指数(CI)、每搏量指数(SI)等心功能指标均较术前有明显改善(P<0.01),但细胞治疗组WMSI、LVEF、ESVI、CI等指标及负荷状态下WMSI(△WMSI)、LVEF(△LVEF)均较对照组改善得更明显(P<0.01);5年超声心动图复查时,细胞治疗组EDVI、CI及LVEF较术前明显改善(P<0.01),并明显优于对照组(P<0.01).结论:自体BM-MNCs治疗对梗死后心功能有长期保护作用.     

冠状动脉内自体骨髓单个核细胞移植治疗心肌梗死的临床研究

目的探讨冠状动脉内自体骨髓单个核细胞移植治疗急性心肌梗死的安全性和疗效.方法 19例拟行介入治疗的急性心肌梗死患者,11例通过放置于梗死相关动脉内的球囊导管,进行自体骨髓单个核细胞移植.另外8例对照组患者以生理盐水代替细胞进行移植.结果 3个月随访时,在细胞治疗组梗死的范围显著缩小(32.4%±4.8%到16.9%±2.9%,P<0.001),与对照组相比也明显较小(16.9%±2.9% 比28.1%±2.8%,P<0.001).只有在细胞治疗组,梗死的心室壁运动速度明显增加(2.05cm/s±1.08cm/s到4.47cm/s±0.59cm/s,P<0.001).细胞治疗组左心室(左室)射血分数,收缩期室壁增厚率以及梗死区心肌灌注显著提高.结论自体骨髓单个核细胞冠状动脉内移植安全有效.其疗效可能与骨髓细胞引起的心肌再生和血管新生有关.     

自体骨髓单个核细胞移植对扩张型心肌病大鼠心功能的影响

目的:研究大鼠骨髓单个核细胞(MBMCs)移植对扩张型心肌病(DCM)大鼠心功能的影响。方法:无菌条件下取成年雄性近交系Wistar大鼠股骨和胫骨,常规抽取骨髓,分离制备MBMCs悬液。对150只成年雄性近交系Wistar大鼠皮下注射大剂量异丙肾上腺素170mg/kg,qd,连续2d,建立DCM模型。造模2周后,以左室射血分数(LVEF)<45%为标准入选试验组,将大鼠随机分成移植组(28只)、对照组(26只)和假手术组(26只),开胸,直视下在左心室前壁行心肌注射。移植组注射4,6二乙酰基-2-苯基吲哚(DAPI)标记的MBMCs悬液10μl(含5×106个细胞);对照组注射等量磷酸盐缓冲溶液(PBS);假手术组仅开胸和关胸。于移植后4和8周,分批分组进行超声心动图、血流动力学检测。结果:与对照组和假手术组比较,移植组左室收缩和舒张末容积(LVEDV、LVESV)减小(均P<0·01),短轴缩短率(FS)和LVEF增大(均P<0·01);左室收缩压力(LVPES)、压力速率最大值(dp/dtmax)明显升高(均P<0·01),而左室舒张末压力(LVPED)显著下降(P<0·01)。对照组和假手术组心腔呈进行性扩大,心肌室壁运动功能障碍明显,心功能逐渐恶化,在第4周时,2组分别有3只和2只出现心室腔反流,反流量0·002~0·006ml;在第7和8周时,分别有2只和1只出现反流,量较4周多,最大达0·011ml。结论:MBMCs移植可有效防止DCM心室腔扩大,促进血管和心肌再生,修复受损心肌,有效改善心功能。     

自体骨髓单个核细胞移植对肝硬化患者血清白蛋白的影响

目的探讨经肝动脉插管自体骨髓单个核细胞(BM-MNCs)移植对肝硬化患者血清白蛋白(ALB)的影响。方法 201例肝硬化患者中,131例进行自体骨髓单个核细胞移植,70例为对照。骨穿采集自体骨髓,分离纯化单个核细胞将其经肝动脉插管移植入肝脏。分别于移植后4、8、12及24周观察ALB变化情况,比较不同Child-Pugh分级肝硬化患者ALB的改变。结果移植组患者移植前血清ALB平均为(29.33±3.92)g/L,移植后第4、8、12、24周分别为(32.37±4.63)g/L、(32.82±4.84)g/L、(32.95±5.10)g/L和(32.22±5.87)g/L。移植后24周内血清ALB水平较移植前显著升高,而对照组则无明显变化,两组比较差异有统计学意义。移植组中,Child-PughA、B级患者血清ALB改善程度大于C级患者。移植后无严重不良事件发生。结论自体骨髓单个核细胞移植能提高肝硬化患者血清ALB水平,对Child-PughA、B级患者改善明显。     

单光子发射型计算机断层心肌灌注显像对PTCA的疗效评估

用运动－静息单光子发射型计算机断层（SPECT）心肌灌注显像对18例经皮腔内冠状动脉成形术（PTCA）的患者追踪观察。结果显示，PTCA后患者运动耐量增加；放射性异常积分及靶心缺损范围明显降低，说明近期缺血明显改善。发现1例再缺血经冠状动脉造影提示再狭窄。8例多支病变中，有6例仅进行部分血运重建，SPECT显示缺血严重区域，相关血管多为严重病变血管。对12例心肌梗塞患者梗塞边线带99mTC－MIBI摄取比值测定表明，PTCA前摄取比值小于30％的室壁节段，术后摄取比值仍无增加，提示是否对其相应血管进行扩张应慎重考虑。表明SPECT对PTCA后近期疗效评估及探测再狭窄具有较高的实用价值。     

Molecular imaging of plaques in coronary arteries with PET and SPECT

Coronary artery disease remains a major cause of mortality. Presence of atherosclerotic plaques in the coronary artery is responsible for lu-men stenosis which is often used as an indicator for determining the severity of coronary artery disease. However, the degree of coronary lumen stenosis is not often related to compromising myocardial blood flow, as most of the cardiac events that are caused by atherosclerotic plaques are the result of vulnerable plaques which are prone to rupture. Thus, identification of vulnerable plaques in coronary arteries has become increas-ingly important to assist identify patients with high cardiovascular risks. Molecular imaging with use of positron emission tomography （PET） and single photon emission computed tomography （SPECT） has fulfilled this goal by providing functional information about plaque activity which enables accurate assessment of plaque stability. This review article provides an overview of diagnostic applications of molecular imaging tech-niques in the detection of plaques in coronary arteries with PET and SPECT. New radiopharmaceuticals used in the molecular imaging of coro-nary plaques and diagnostic applications of integrated PET/CT and PET/MRI in coronary plaques are also discussed.     

Outcomes of autologous bone marrow mononuclear cell transplantation in decompensated liver cirrhosis

AIM: To determine the long-term efficacy of autologous bone marrow mononuclear cells (BM-MNCs) transplantation in terms of improving liver function and reducing complications in patients with decompensated cirrhosis.METHODS: A total of 47 inpatients with decompensated liver cirrhosis were enrolled in this trial, including 32 patients undergoing a single BM-MNCs transplantation plus routine medical treatment, and 15 patients receiving medical treatment only as controls. Forty-three of 47 patients were infected with hepatitis B virus. Bone marrow of 80-100 mL was obtained from each patient and the BM-MNCs suspension was transfused into the liver via the hepatic artery. The efficacy of BM-MNCs transplantation was monitored during a 24-mo follow-up period.RESULTS: Liver function parameters in the two groups were observed at 1 mo after BM-MNCs transfusion. Prealbumin level was 118.3 ± 25.3 mg/L vs 101.4 ± 28.7 mg/L (P = 0.047); albumin level was 33.5 ± 3.6 g/L vs 30.3 ± 2.2 g/L (P = 0.002); total bilirubin 36.9 ± 9.7 mmol/L vs 45.6 ± 19.9 mmol/L (P = 0.048); prothrombin time 14.4 ± 2.3 s vs 15.9 ± 2.8 s (P = 0.046); prothrombin activity 84.3% ± 14.3% vs 74.4% ± 17.8% (P = 0.046); fibrinogen 2.28 ± 0.53 g/L vs 1.89 ± 0.44 g/L (P = 0.017); and platelet count 74.5 ± 15.7 × 10⁹/L vs 63.3 ± 15.7 × 10⁹/L (P = 0.027) in the treatment group and control group, respectively. Differences were statistically significant. The efficacy of BM-MNCs transplantation lasted 3-12 mo as compared with the control group. Serious complications such as hepatic encephalopathy and spontaneous bacterial peritonitis were also significantly reduced in BM-MNCs transfused patients compared with the controls. However, these improvements disappeared 24 mo after transplantation.CONCLUSION: BM-MNCs transplantation is safe and effective in patients with decompensated cirrhosis. It also decreases the incidence of serious complications.     

自体骨髓单个核细胞移植治疗糖尿病下肢血管病变疗效及其与血清肝细胞生长因子的关系

目的探讨自体骨髓单个核细胞移植治疗糖尿病下肢血管病变的疗效及其与血清肝细胞生长因子(HGF)水平的关系。方法选择2006年6月至2009年6月沈阳市第七人民医院79例糖尿病下肢血管病变患者,分为常规治疗组(A组,40例,80条患肢)和自体骨髓单个核细胞移植治疗组(B组,39例,78条患肢),治疗6个月后对疗效及其与血清HGF关系进行评估。结果(1)B组治疗后1周肢体疼痛、患肢冷感、皮肤温度、血清HGF与B组治疗前及A组治疗后1周比较差异有统计学意义(P0.05),并与血清HGF存在相关性(P0.05)。(2)B组治疗后3个月、6个月各项临床观察指标与B组治疗前及A组治疗后相同时间点比较差异均有统计学意义(P0.05)。结论自体骨髓单个核细胞移植技术治疗糖尿病下肢血管病变可以提高疗效,不会导致由于血清HGF长期增高引起的副反应。     

Diagnostic value of 18F-FDG PET in the assessment of myocardial viability in coronary artery disease: A comparative study with 99mTc SPECT and echocardiography

ObjectiveTo investigate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography （18F-FDG PET） in the as-sessment of myocardial viability in patients with known coronary artery disease （CAD） when compared to99mTc single photon emission computed tomography （SPECT） and echocardiography, with invasive coronary angiography as the gold standard.MethodsThirty patients with diagnosed CAD met the selection criteria, with 10 of them （9 men, mean age 59.5 ± 10.5 years） undergoing all of these imaging proce-dures consisting of SPECT and PET, echocardiography and invasive angiography. Diagnostic sensitivity of these less invasive modalities for detection of myocardial viability was compared to invasive coronary angiography. Inter- and intra-observer agreement was assessed for di-agnostic performance of SPECT and PET.ResultsOf all patients with proven CAD, 50% had triple vessel disease. Diagnostic sensitivity of SPECT, PET and echocardiography was 90%, 100% and 80% at patient-based assessment, respectively. Excellent agreement was achieved between inter-observer and intra-observer agreement of the diagnostic value of SPECT and PET in myocardial viability （k= 0.9）. Conclusion18F-FDG PET has high diagnostic value in the assessment of myocardial viability in patients with known CAD when com-pared to SPECT and echocardiography. Further studies based on a large cohort with incorporation of18F-FDG PET into patient management are warranted.     

Characteristics of patients with abnormal stress technetium Tc 99m sestamibi SPECT studies without significant coronary artery diameter stenoses

BACKGROUND: Single-photon emission computed tomography (SPECT) sestamibi (MIBI) is an excellent tool for detection of coronary artery disease (CAD), preoperative risk assessment, and follow-up management after coronary revascularization. While the sensitivity of MIBI SPECT for detecting CAD has been reported to exceed 90%, the specificity ranges between 53-100%. HYPOTHESIS: The study was undertaken to assess characteristics of patients with abnormal stress technetium Tc99m sestamibi SPECT (MIBI) studies without significant coronary artery diameter stenoses (< 50%). METHODS: Between January 1999 and November 2000, 270 consecutive patients were referred for coronary angiography due to reversible MIBI uptake defects during exercise. In 41 patients (15%; 39% women, mean age 59 +/- 9 years), reversible MIBI uptake defects were assessed although coronary angiography showed no significant CAD. These patients were compared with age- and gender-matched patients with perfusion abnormalities (39% women, mean age 60 +/- 9 years), due to significant CAD (coronary artery stenosis > 50%). RESULTS: There were no significant differences between the two groups regarding body mass index, left bundle-branch block (LBBB), or method of stress test (dipyridamole in patients with LBBB or physical inactivity [n = 11] and exercise in all the others [n = 30]). Left ventricular hypertrophy (44 vs. 23%, p = 0.05) and left anterior fascicular block (LAFB) (17 vs. 0%, p = 0.005) were more common in patients with perfusion abnormalities with no significant CAD, whereas ST-segment depression during exercise (17 vs. 37% p = 0.05) and angina during exercise (15 vs. 29%, p = 0.02) were significantly less common than in patients with abnormal MIBI perfusion studies and angiographically significant CAD. Sestamibi uptake defects during exercise were significantly smaller in patients without significant CAD than in matched controls with significant CAD (p < 0.0004). CONCLUSION: Of 270 consecutive patients, 41 (15%) referred to coronary angiography due to reversible MIBI uptake defects showed coronary artery stenoses < 50%. Twenty-six (10%) of these presented angiographically normal coronary arteries. The significantly higher proportion of left ventricular hypertrophy and LAFB in patients with reversible MIBI uptake defects without significant CAD suggest microvascular disease, angiographically underestimated CAD, and conduction abnormalities as underlying mechanisms.     

自体骨髓间充质干细胞和单个核细胞移植治疗冠心病的临床研究

目的　研究自体骨髓间充质干细胞 (BMSCs)和单个核细胞 (BMMNCs)经冠状动脉 (冠脉 )移植对冠心病、心肌梗死患者心功能的影响及其安全性。方法　 10例冠心病伴心肌梗死患者 ,通过冠脉转运将BMMNCs植入心肌梗死区 ,术前和术后 6个月分别行99mTc MIBI心肌灌注显像、二维超声心动图及动态心电图检查。结果　 3例患者因心肌梗死罪犯血管狭窄小于 5 0 %未行经皮冠状动脉介入术 (PCI) ,仅移植干细胞。余 7例患者在梗死相关冠脉开通后注入干细胞。 10例患者二维超声心动图检查示左心室射血分数 (LVEF)较术前平均增加 10 5 % (4 0 %～ 18% ) ,左心室舒张末期内径(LVDd)较术前平均减少 2 2mm(- 4mm～ 8mm) ,99mTc MIBI显示梗死部位心肌灌注明显改善。术中及术后随访 6～ 12月均无心律失常和其它合并症发生。结论　自体BMSCs和MMNCs经冠脉移植治疗冠心病心肌梗死 ,可以抑制左心室重构 ,改善心脏功能。     

The use of coronary artery calcium scanning in detection and risk stratification of coronary artery disease

Coronary artery calcium (CAC) scan can be obtained using chest computed tomography, with no use of contrast agents, and with a relatively low radiation exposure. The mere absence of calcium is associated with a good prognosis in asymptomatic subjects and in patients at low to medium risk of coronary artery disease. CAC can be quantified in different ways, with higher scores being associated with a higher cardiovascular risk. CAC carries both diagnostic and prognostic information over and above that determined by classical risk factors. This paper presents the overview of the current use of CAC scanning, its advantages and limitations, as well as potential future applications.