自体骨髓间充质干细胞肝动脉移植治疗失代偿期肝硬化

背景：国内外研究均表明自体骨髓千细胞对失代偿期肝硬化具有一定治疗作用，但针对失代偿期乙肝肝硬化患者缺乏系统有对照的临床研究。一目的：观察自体骨髓间充质干细胞移植对乙肝肝硬化失代偿期患者的临床疗效及安全性。方法：将67例乙肝肝硬化失代偿期患者按照是否同意进行干细胞移植治疗分为2组，对照组34例采用常规口服核苷类似物抗病毒并对症支持治疗；治疗组33例在对照组常规治疗基础上，行自0S骨髓间充质干细胞经肝动脉移植。分别在治疗前、治疗后4，12，24周观察肝功指标、症状、体征以及不良反应情况，并行2组对比。结果与结论：治疗后所有患者症状均有不同程度改善；至治疗后4周部分肝功指标指标均较治疗前有明显改善，治疗组谷丙转氨酶、凝血酶原活动度、胆碱酯酶水平与对照组相比差异有显著性意义（P〈0．05）；至治疗后12，24周，两组患者谷丙转氨酶、白蛋白、总胆红素、凝血酶原活动度、胆碱酯酶水平较治疗前均有显著改善（P〈0．05），且在同一时间点2组相比，各项指标差异均有显著性意义（P〈0．05）。治疗后4，12，24周2组患者Child-Pugh计分及终末期肝病模型评分均有所下降，与治疗前相比差异有显著性意义；且同一时间点2组相比，差异有显著性意义。结果提示，在传统口服核苷类似物抗病毒等综合治疗乙肝肝硬化基础上联合自体骨髓间充质干细胞经肝动脉移植治疗失代偿期肝硬化，能更有效地改善肝功和凝血功能，患者症状好转，相对安全，风险较低。

Hepatic arterial transplantation of autologous bone marrow mesenchymal stem cells in treatment of decompensated liver cirrhosis

BACKGROUND： Autologous bone marrow mesenchymal stem cells can treat decompensated liver cirrhosis, however, little evidence has addressed the controlled clinical research in hepatitis B patients with decompensateC live cirrhosis. OBJECTIVE： To evaluate the clinical efficacy and safety of autologous bone marrow mesenchymal stem cells in the treatment of hepatitis B with decompensated live cirrhosis. METHODS： A total of 67 hepatitis B patients with decompensated live cirrhosis were divided into two groups according to their wis.hes to receive stem cell transplantation. The control group （34 patients） only received oral administration of nucleoside analog antivirus and supportive treatment. The treatment group （33 patients） received autologous bone marrow mesenchymal stem cells transplantation via hepatic artery plus antivirus and supportive treatment. The liver functional index, clinical signs and symptoms, adverse reactions were observed and compared at 4, 12, 24 weeks after treatment. RESULTS AND CONCLUSION： After treatment, all patients＇ symptoms were improved to varying degrees. After 4 weeks of treatment, the liver functional indexes were all significantly improved compared with before treatment, the levels of alanme aminotransferase, cholinesterase and prothrombin activity in treatment group were significantly ameliorated compared with control group （P 〈 0.05）. At 12 and 24 weeks of treatment, the alanme aminotransferase, albumin, total bilirubin, cholinesterese and prothrombin activity in control group and treatment group showed statistically significant differences compared with before treatment （P 〈 0.05）. At the same time point, all the indicators in the treatment group were significantly ameliorated compared with control group （P 〈 0.05）. The Child-pugh score and model for end-stage liver disease score declined at 4, 12, 24 weeks after treatment, showing significant differences compared with before treatment. The difference was also significant at the same time point between two groups. The treatment of nucleoside analogue antivirus combined with autologous bone marrow mesenchymal stem cells transplantation on hepatitis B patients with decompensated liver cirrhosis is an effective method to improve liver function and blood coagulation function, with symptom improvement, safety and low risk.