粒细胞刺激因子动员A体外周血干细胞冠状动脉内移植治疗急性心肌梗死疗效观察

目的 观察经皮冠状动脉内移植白体外周血干细胞（peripheral blood stem cells,PBSC）治疗急性心肌梗死（acute myocardial infarction,AMI）的疗效.方法 我院2006-04至2007-08人选18例AMI患者,纽约心脏病协会（New York Heart Association,NYHA）心功能分级Ⅲ～Ⅳ级,左室射血分数（LVEF）＜45%,年龄＜75岁,为干细胞移植组,患者在药物治疗的基础上行粒细胞集落刺激因子皮下动员自体骨髓干细胞,连用5 d,在第6天分离PBSC,经处理后将采集到的干细胞悬液部分经over-the-wire球囊中心腔注入到已行血运重建的罪犯血管远端.在PBSC动员、采集及经冠脉回输过程中观察有无不良反应.选用同期住院的符合入选标准,冠脉造影显示梗死部位及罪犯血管与移植组相匹配的接受标准常规治疗的患者18例,为对照组.3～6个月随访,包括临床、实验室指标、二维超声心动图、6 min步行距离（6 MWT）.结果 移植组术后6个月与术前相比：左室收缩末期内径（LVESd）减小,（42.22±8.43）mm与（39.67±8.06）mm,P＜0.0l;LVEF明显提高,（41.44±4.27）%与（46.22±4.39）%,P＜0.01;6 MWT明显提高,（225.06±38.13）m与（288.12±34.54）m,P＜0.01.对照组介入术后6个月与术前相比较,LVESd、LVEF差异均无统计学意义（P=0.331、0.052）;6 MWT有明显提高,（226.67±47.38）m与（264.56±28.67）m,P＜0.01;不良反应：在PBSC动员、分离、采集及回输过程中总的不良反应共3例次.结论 经皮冠状动脉内移植自体PBSC治疗AMI可有效改善心功能,提高运动耐量,且安全.

Effects of peripheral blood stem cells mobilization with granulocyte-colony stimulating factors and their transcoronary transplatation in patients with acute myocardial infarction

Objective To investigate the safety and effieaev of intraeoronary transplantation of G - CSF mobilized autologous peripheral blood stem cells （PBSC） in patients with acute myoeardial in farction （AMI）. Methods Eighteen patients with AM/were recruited. The eligibility criteria were as follows： New York Heart Association class Ⅲ- Ⅳ, an ejection fraction lower than 45% , no more than 75 years of age. Baseline evaluations included a complete elinieal evaluation ,laboratory evaluation ,6 -minute walking tests, and 2 - D eehoeardiography. Patients were assigned to receive intraeoronaD, PBSC transplantation following bone marrow cell mobiliza- tion by G -CSF （600 μg/day subeutaneously for 5 days） in addition to standard drug theraphy . One day after G- CSF treatment was finished the patients mononuelear cells were harvested by a separator in a volume 62 ml and were infused into the artery through balloon center lumen. As an internal reference group reflecting the standard care, we respectively selected each patient who matched for study population. All patients were followed up for 3 -6 months according to standard protocols and with the stone procedures used as base- line. Results Left ventrieular function was significantly improved after 6 months, LVEF （41.44 ± 4.27 ） % vs （46.22 ± 4.39） % ,P 〈0.01; LVESd （42.22±8.43） mmvs （39.67±8.06） mm,P〈0.01;6MWT（225.06±38.13） mvs （288.12±34.54） re,P〈 0.01; while these parameters remained unchanged in the control group except 6 MWT（ 226.67 ± 47.38 ）m vs （264.56± 28.67 ） m,P 〈 0.01. No severe side effeets of G - CSF treatment were observed. Conclusions The Intraeoronary transplantation of G - CSF mobilized autologous peripheral blood stem cells in patients with AMI favorably influences cardiac function and can be performed without adverse periprocedural events.