经冠状动脉骨髓单个核细胞移植治疗原发性扩张型心肌病的远期疗效Long term outcomes of autologous bone marrow mononuclear cells transplantation on patients with idiopathic dilated cardiomyopathy
章轶琦,黄榕翀,姚康,钱菊英,牛玉宏,孙爱军,邹云增,葛均波
摘要(Abstract)：
目的研究经冠状动脉骨髓单个核细胞移植治疗原发性扩张型心肌病的远期疗效。方法入选18例原发性扩张型心肌病患者,随机分为对照组8例和移植组10例,两组均给予常规抗心力衰竭药物治疗。移植组接受经冠状动脉自体骨髓单个核细胞移植。两组术前、术后12个月分别检测血常规及生化指标(肝功能、肾功能、血糖、血脂、高敏C反应蛋白),术前、术后12个月分别行超声心动图、心电图、6min步行试验,术前和术后12个月行心脏核磁共振(MRI)检查测定左室射血分数(LVEF)。随访至两年,记录患者年住院天数,以死亡作为研究终点。结果术后12个月细胞移植组6min步行路程较术前有明显增加(521.7±78.2m比321.5±63.7m,P<0.05),LVEF变化值在细胞移植组与对照组间存在统计学差异(3.1%±4.5%比-2.4%±4.6%,P=0.019),但LVEF值较术前无统计学差异,左室舒张末内径(LVEDd)在移植组及对照组间存在明显差异(67.2±1.0mm比69.5±1.1mm,P<0.01)。研究过程中未发现有发热、过敏反应、栓塞事件等发生。结论骨髓单个核细胞移植治疗原发性扩张型心肌病安全可行,可延长6min步行路程,减小LVEDd。
关键词(KeyWords)： 心肌病,扩张型;细胞移植
基金项目(Foundation): 国家科技攻关计划项目(2004BA714B05-2);; 上海市领军人才计划(C8-21)
作者(Author): 章轶琦,黄榕翀,姚康,钱菊英,牛玉宏,孙爱军,邹云增,葛均波
参考文献(References)：
- [1]Ishida M,Tomita S,Nakatani T,et al.Bone marrowmononucle-ar cell transplantation had beneficial effects on doxorubicin-in-duced cardiomyopathy.J Heart Lung Transplant,2004,23:436-445.
- [2]Galli D,Innocenzi A,Staszewsky L,et al.Mesoangioblasts,Vessel-Associated Multipotent Stem Cells,Repair the InfarctedHeart by Multiple Cellular Mechanism:AComparison With Bone Marrow Progenitors,Fibroblasts,and Endothelial Cells.Arterio-scler Thromb Vasc Biol,2005,25:692-697.
- [3]Guilherme VS,Silvio L,Joao ARA,et al.Mesenchymal Stem Cells Differentiate into an Endothelial Phenotype,Enhance Vas-cular Density,and Improve Heart Function in a Canine Chronic Ischemia Model.Circulation,2005,111:150-156.
- [4]Jain M,Pfister O,Roger JH,et al.Mesenchymal stem cells in the infracted heart.Coronary Artery Disease,2005,16:93-97.
- [5]Michael SL,and Raj RM.Stem Cell Transplantation in Myocar-dial Infarction.Rev Cardiovasc Med,2004,5:82-98.
- [6]李延林,葛均波,钱菊英,等.急诊经冠状动脉自体骨髓单个核细胞移植治疗急性心肌梗死的临床研究(TCT-STAMI).中国介入心脏病学杂志,2005,13:142-145.
- [7]马剑英,钱菊英,葛均波,等.首过及延迟增强的磁共振成像技术在心肌梗死中的价值.中华心血管病杂志,2005,33:1-4.
- [8]Schachinger V,Assmus B,Britten MB,et al.Transplantation of progenitor cells and regeneration enhancement in acute myocardi-al infarction:final one-year results of the TOPCARE-AMI Trial.J Am Coll Cardiol,2004,44:1690-1699.
- [9]Wollert KC,Meyer GP,Lotz J,et al.Intracoronary autologous bonemarrow cell transfer after myocardial infarction:the BOOST randomized controlled clinical trial.Lancet,2004,364:141-148.
- [10]黄榕翀,姚康,邹云增,等.急诊经冠状动脉自体骨髓单个核细胞移植治疗急性下壁心肌梗死长期随访观察.中华医学杂志,2006,86:1107-1110.
- [11]Noritoshi N,Kenji K,Takefumi I,et al.Transplantation of Mes-enchymal Stem Cells Improves Cardiac Function in a Rat Model of Dilated Cardiomyopathy.Circulation,2005,112:1128-1135.
- [12]Guarita-Souza LC,Carvalho KAT,Woitowicz V,et al.Simulta-neous Autologous Transplantation of Cocultured Mesenchymal Stem Cells and Skeletal Myoblasts Improves Ventricular Function in a Murine Model of Chagas Disease.Circulation,2006,114(suppl I):I120-I124.
- [13]黄榕翀,姚康,李延林,等.经冠状动脉骨髓单个核细胞移植治疗原发性扩张型心肌病的安全性与疗效近期观察.中华心血管病杂志,2006,34:111-113.
- [14]王建安,谢小洁,何红,等.骨髓间质干细胞移植治疗原发性扩张型心肌病的疗效与安全性.中华心血管病杂志,2006,34:107-110.
- [15]郭素萍,高传玉,刘煜昊,等.自体骨髓单个核细胞移植治疗扩张型心肌病的临床观察.中国临床医学,2006,13:19-21.
- [16]陈延军,张瑶,尹新华,等.自体骨髓单个核细胞移植治疗扩张型心肌病的临床研究.中国介入心脏病学杂志,2006,14:108-110.