MELD-Na模型评价自体骨髓干细胞移植治疗失代偿期肝硬化的疗效

目的:评价自体骨髓干细胞移植对肝硬化失代偿的作用,探讨干细胞移植治疗终末期肝病的合适时机.方法:将79例符合肝硬化失代偿期的患者分为治疗组36例和对照组43例,两组均给予内科综合治疗,治疗组在内科综合治疗的基础上行经门静自体骨髓干细胞移植术治疗,通过各项临床检验数据,建立MELD-Na评分,并统计两组短期(3个月)预后,比较两组的MELD-Na评分及ROC曲线下的面积及其预后.结果:治疗3个月后,治疗组平均MELD-Na分值明显低于对照组,在MELD-Na分值的分布上,治疗组MELD-Na分值在20以下者分布多.同时发现治疗组AOC曲线下的面积明显小于对照组.统计治疗组和对照组短期死亡率,发现治疗组死亡4例,对照组为16例,两者比较有明显差异.结论:自体骨髓干细胞经门静脉移植治疗失代偿期肝硬化可以使MELD-Na分值下降,影响患者短期预后,减少近期死亡率.其起效时间大概需要12周.本研究还提示自体骨髓干细胞移植对于MELD-Na分值大于20的患者效果不显著.

Evaluation of the Efficacy of Autologous Bone Marrow Stem Cells Transplantation in the Patients with Decompensated Liver Cirrhosis by Using MELD-Na Model

Objective: To research retrospectively the efficacy of antilogous bone marrow stem cells for transplantation in the patients with decompensated liver cirrhosis.Methods: Seventy-nine cases with decompensated liver cirrhosis were divided into treatment group of 36 patients and a control group of 43 patients.The control group were given conventional treatment,while the treatment group underwent bone marrow stem cells transplantation through portal vein autologous.The MELD-Na model was adopted to evaluate the short-term outcomes(three months) of the two groups,and MELD-Na scores,ROC curves of the area,and the prognosis between the two groups were compared.Results: After three months,the average MELD-Na score in the treatment group was significantly lower than in the control group,and most MELD-Na scores in the treatment group were less than 20 below.Area under the curve(AOC) in the treatment group was significantly smaller than that of the control group.Four cases in treatment group and 16 cases in control group were died,and statistical analysis showed significant difference in mortality.Conclusion: MELD-Na scores and mortality were decreased in autologous bone marrow stem cell transplantation in the treatment of portal vein with decompensated liver cirrhosis in short-term follow-up.The study showed the effect could be observed 12 weeks after transplantation,and the effect of transplantation was not significant for the patients with MELD scores more than 20.