自体外周血干细胞移植治疗急性心肌梗死的随访观察

目的观察经皮经腔冠状动脉内移植自体外周血干细胞(PBSC)治疗急性心肌梗死(AMI)的随访情况。方法 AMI患者70例,分为干细胞移植组和对照组各35例,干细胞移植组在常规急性心肌梗死治疗(药物与介入治疗)基础上加用粒细胞集落刺激因子(G-CSF)皮下注射动员自体骨髓干细胞,连续5 d,第6天分离外周血干细胞悬液,将采集后的干细胞悬液经overthe wire球囊导管中心腔注入梗死相关动脉(IRA),进行外周血干细胞移植;对照组反给予常规方法(药物与介入)治疗。2组患者在移植前及移植后5.2年(4.8⁵.5年)应用超声心动图评价左室形态及心功能变化、室壁节段性运动积分、生存率及心脏事件发生率,并进行比较。结果随访5.2年,干细胞移植组完成随访30例,对照组28例。2组均无死亡病例,对照组因急性左心衰住院6例(21.4%),高于移植组1例(3.3%)(P<0.05)。干细胞移植组左室射血分数(LVEF)由(50.0±8.2)%升高至(56.0±8.9)%(P<0.05),左室壁节段性运动积分指数WMSI由(1.219±0.190)下降至(1.111±0.108)(P<0.05),左室收缩末容积(LVESV)由(63.8±24.9)ml减少至(53.1±24.6)ml(P<0.05),左室舒张末容积(LVEDV)无显著性变化,由(134.2±36.7)ml降至(119.2±30.3)ml(P>0.05)。对照组介入术前及术后5.2年LVEF、WMSI、EDV及ESV均无显著性变化。结论经皮经腔冠状动脉内移植自体外周血干细胞治疗AMI可减轻左室重构,改善心功能。

The long period observation of autologous peripheral blood stem cell transplantation by intracoronary infusion in patients with acute myocardial infarction

Objective To observe the effect of percutaneous intracoronary transplantation of autologous peripheral blood stem cell （ PBSC） on treatment of acute myocardial infarction （ AMI） .Methods Seventy cases of AMI were divided in-to transplantation group and control group with 35 cases in each group , stem cell transplantation group underwent the conven-tional therapy for acute myocardial infarction （ drug and interventional therapy ） combined with granulocyte colony-stimulating factor （G-CSF） subcutaneous injection of mobilization of autologous bone marrow stem cells last for 5 days, suspense separa-ted peripheral blood stem cells at the sixth days , over the wire balloon catheter center cavity , stem cell suspension was injected into the infarct related artery （ IRA） , peripheral blood stem cell transplantation were performed;the control group treated with routine method （ anti-drug and interventional ） treatment.During 5.2 years before and after transplantation （ 4.8 -5.5 years）, echocardiography was performed to evaluate left ventricular configuration and function of segmental ventricular wall motion score, survival rate and cardiac events between the 2 groups of patients.Results Follow-up was last for 5.2 years, stem cell transplantation group were 30 cases, 28 cases in the control group .The 2 groups had no death cases , the control group had 6 cases （21.4%） of acute left heart failure, higher than the transplantation group of 1 cases （3.3%, P 〈0.05）. Stem cell transplantation group ’s left ventricular ejection fraction （LVEF） was increased from （50.0 ±8.2）% to （56.0 ± 8.9）%（ P 〈0.05）, left ventricular wall motion score index （WMSI） was decreased from （1.219 ±0.190） to （1.111 ± 0.108） （ P 〈0.05）.End systolic volume （LVESV） was decreased from （63.8 ±24.9） ml to （53.1 ±24.6） ml （ P 〈0.05）, End diastolic volume （LVEDV） had no significant change from （134.2 ±36.7） ml to （119.2 ±30.3） ml （ P 〉0.05）.L