骨髓间充质干细胞在急性心肌梗死后心室重构中的应用☆

背景：动物实验和初期的临床研究表明，干细胞移植可以取代坏死心肌细胞、增加有功能心肌细胞的数量，改善心功能，从而为心肌梗死的治疗开辟了一条崭新的途径。 目的：观察心肌梗死后自体骨髓间充质干细胞移植及骨髓动员对心功能的影响。 方法：经猪髂前上棘抽取骨髓30 mL，培养得到骨髓间充质干细胞。15只猪分为3组，模型组仅建立心肌梗死模型，干细胞移植组在造模3 h后经冠状动脉注射骨髓间充质干细胞，干细胞动员组在造模3 h后连续5 d注射粒细胞集落刺激因子    150 μg/(kg?d)。 结果与结论：心肌梗死后8周，干细胞动员组、干细胞移植组左心室收缩、舒张末期内径都明显减小，射血分数较心肌梗死前提高，但差异无显著性意义(P > 0.05)；干细胞动员组及干细胞移植组血清血管内皮生长因子水平较心肌梗死前有上升趋势(P < 0.05)；干细胞动员组和干细胞移植组梗死交界区的毛细血管密度均大于模型组(P < 0.05)。提示心肌梗死后行自体骨髓间充质干细胞移植及骨髓动员均能明显改善心功能，但具体效果仍需进一步大样本实验研究。 关键词：缺血性心脏病；心力衰竭；骨髓间充质干细胞；血管再生；粒细胞集落刺激因子 doi:10.3969/j.issn.1673-8225.2012.10.009

Bone marrow-derived mesenchymal stem cells for ventricular remodeling following acute myocardial infarction

BACKGROUND: Animal experiments and preliminary clinical studies have demonstrated that transplantation of stem cells can replace necrotic myocardial cells, increase the number of myocardial cells with functions and improve cardiac function, thereby providing a brand-new pathway for treatment of myocardial infarction. OBJECTIVE: To investigate the effects of transplantation of autologous bone marrow mesenchymal stem cells and bone marrow mobilization after myocardial infarction on cardiac functions. METHODS: 30 mL bone marrow was taken from pig anterior superior iliac spine for harvesting bone marrow mesenchymal stem cells. Fifteen pigs were assigned to three groups. In the model group, only myocardial infarction was induced. In the stem cell transplantation group, at 3 hours after myocardial infarction induction, bone marrow mesenchymal stem cells were transfused via coronary vein. In the stem cell mobilization group, at 3 hours after myocardial infarction induction, granulocyte colony-stimulating factor (150 μg/kg per day) was administered for a total of 5 successive days. RESULTS AND CONCLUSION: In the stem cell mobilization group and stem cell transplantation group, left ventricular end systolic diameter and left ventricular end-diastolic diameter were slightly, but not significantly, decreased, and ejection fraction was slightly, but not significantly, increased (P > 0.05) at 8 weeks after myocardial infarction compared with before infarction. In the stem cell mobilization group and stem cell transplantation group, vascular endothelial growth factor level was significantly increased at 8 weeks after myocardial infarction than before infarction (P < 0.05). At 8 weeks after myocardial infarction, capillary density at the infarcted zone was significantly greater in the stem cell mobilization group and stem cell transplantation group than in the model group (P < 0.05). These findings suggest that after myocardial infarction, autologous bone marrow mesenchymal stem cell transplantation and bone marrow mobilization can significantly improve cardiac function, but the precise efficacy requires further investigation via large-size sample.