自体骨髓干细胞原位移植治疗急性心肌梗死的临床研究

目的:用粒细胞集落刺激因子(G-CSF)动员自体骨髓干细胞进入心肌梗死部位原位移植以修复梗死心肌组织,探讨其对急性心肌梗死患者心肌梗死面积及心功能的影响。方法:25例初次急性心肌梗死患者在入院后随机分为干细胞原位移植组(n=12)和对照组(n=13)。干细胞原位移植组于入院后在常规治疗基础上加用G-CSF动员自体骨髓干细胞进行心肌梗死原位移植;对照组按急性心肌梗死常规方法治疗。于入院第(1、28d)描记常规12导联心电图,采用Wagner的QRS波群记分法评价心功能,于入院(7、28d)行核素心肌灌注断层显像,测量心肌梗死面积。结果:G-CSF治疗4周,干细胞原位移植组QRS记分值明显降低,显著低于对照组(P＜0.05);心肌梗死面积由36.0%±8.3%下降至18.0%±5.8%,显著小于对照组(P＜0.05)。结论:用G-CSF动员自体骨髓干细胞来修复坏死心肌组织的"干细胞原位移植"疗法,能减小心肌梗死的范围,改善心功能。

Repair of infarcted myocardium by intramyocardial transplantation of mobilized autologous bone marrow stem cells in humans

AIM:To investigate the effects of in situ transplantation of mobilized autologous bone marrow stem cells on infarction size and cardiac function in patients with acute myocardial infarction.METHODS:25 patients with first acute myocardial infarction were randomly divided into stem cells in situ transplantation group and control group, 12 patients in stem cells in situ transplantation group were injected subcutaneously with 300 μg granulocyte colony-stimulating factor(G-CSF) daily for four days in addition to standard therapy. 13 patients in control group were treated with standard therapy alone. The conventional 12 leads electrocardiogram were recorded on 1, 28 days after admission and the cardiac function was scored by the QRS scoring system proposed by Wagner. Furthermore, the infarction size was assessed by radionuclide myocardial perfusion imaging 7, 28 days after admission.RESULTS:4 weeks after admission, the QRS scores decreased, the infarction size reduced significantly in the stem cells in situ transplantation group (from 36.0%±8.3% to 18.0%±5.8%, P＜0.05) compared with the standard therapy group (P＜0.05).CONCLUSION:In situ transplantation of autologous bone marrow stem cells mobilized by G-CSF can repair the infracted myocardium, reduce infarction size and improve cardiac function.