经冠状动脉自体骨髓单个核细胞移植治疗缺血性心力衰竭Intracoronary autologous mononuclear bone marrow cell transplantation for patients with chronic ischemic heart failure
高连如,田海涛,朱智明,王志国,费宇行,徐洪涛,李贤峰,陈宇,贺声,黄友章,张宁坤,王丽华,沈建良,刘惠亮,丁青艾,杨晔
摘要(Abstract)：
目的观察经冠状动脉自体骨髓单个核细胞(mononuclearbonemarrowcell,MBMC)移植治疗缺血性心力衰竭(IHF)的可行性、效果、安全性及不良反应。方法2002年12月至2004年3月,41例缺血性心力衰竭患者入选此前瞻性研究,分为两组。(1)细胞移植组:14例经梗死相关冠状动脉超选择性移植,于气囊充盈下高压注入2mLMBMC(2×106/mL),重复注入6～8次,平均共计(3.28±0.44)×107MBMC;13例经冠状动脉选择性移植,气囊未充盈下高压注入移植细胞,细胞数与上相同。(2)对照常规治疗组:共14例,除细胞移植外其他治疗均相同。结果27例细胞移植患者手术均安全,2例于细胞注入后15～30min感发冷,30min后好转;2例细胞注入时出现短暂自限性室性早搏,术后48h持续心电监测未出现新的心律失常;随访3个月时,细胞移植组心力衰竭症状明显好转,射血分数(EF)和心搏量(SV)增加,左心室收缩末期容积(LVESV)减少,正电子发射体层摄影(PET)心肌代谢显像示代谢活力心肌增加(23.94±7.28)%(P=0.015);术后第3天、第7天脑钠素(BNP)水平较术前明显下降,心钠素(ANP)水平在术后第7天明显上升;随访6个月1例心力衰竭加重再度住院,无一例死亡。对照组心功能恶化,再入院率71.4%,2例死亡。结论自体骨髓单个核细胞经冠状动脉移植修复心肌对改善心功能是安全有效的。
关键词(KeyWords)： 心力衰竭;骨髓细胞;细胞移植
基金项目(Foundation): 首都医学发展科研基金(2003-2025);; 总后医药卫生科研基金课题资助
作者(Author): 高连如,田海涛,朱智明,王志国,费宇行,徐洪涛,李贤峰,陈宇,贺声,黄友章,张宁坤,王丽华,沈建良,刘惠亮,丁青艾,杨晔
参考文献(References)：
- 1HaldemanGA,CroftJB,GilesWH,etal.Hospitalizationofpatients withheartfailure:NationalHospitalDischargeSurvey,1985to1995.AmHeartJ,1999,137:352360.
- 2LevyD,KenchaiahS,LarsonMG,etal.Long termtrendsinthe incidenceofandsurvivalwithheartfailure.NEnglJMed,2002,347:13971402.
- 3PittengerF,MackayA,BeckS,etal.Multilineagepotentialofadult humanmesenchymalstemcell.Science,1999,284:143147.
- 4JiangY,JahagirdarBN,ReinhardtRL,etal.Pluripotencyof mesenchymalstemcellsderivedfromadultmarrow.Nature,2002,418:4149.
- 5KrauseDS,theiseMD,CollectorMI,etal.Multi organ,multi lineage engraftmentbyasinglebonemarrow derivedstemcell.Cell,2001,105:369377.
- 6MakinoS,FukudaK,MiyoshiS,etal.Cardiomyocytescanbe generatedfrommarrowstromalcellsinvitro.JClinInves,1999,103:697705.
- 7OrlicD,KajsturaJ,Chimentis,etal.Bonemarrowcellregenerate infarctedmyocardium.Nature,2001,410:701705.
- 8KocherAA,SchusterMD,SzabolcsMJ,etal.Neovascularizationof ischemicmyocardiumbyhumanbone marrow derivedangioplasty preventscardiomyocyteapoptosis,reducesremodelingandimproves cardiacfunction.NatMed,2001,7:430436.
- 9KamihataH,MattsubaraH,NishiueT,etal.Implantationofbone marrowmononuclearcellsintoischemicmyocardiumenhancescollateral perfusionandregionalfunctionviasidesupplyofangioblasts,angiogenicligandandcytokines.Circulation,2001,104:10461052.
- 10朱智明,高连如,王志国,等.骨髓单个核细胞移植修复梗死心肌的实验研究.第二军医大学学报,2004,8:14.
- 11StrauerBE,BrehmM,ZeusT,etal.Repairofinfarctedmyocardium byautologousintracoronarymononuclearbonemarrowcell transplantationinhumans.Circulation,2002,106:19131918.
- 12PerinEC,DohmannHFR,BorojevicR,etal.Transendocardial,autologousbonemarrowcelltransplantationforsevere,chronicischemic heartfailure.Circulation,2003,107:22942302.
- 13ClericoA,EmdinM.Diagnosticaccuracyndprognosticrelevanceof themeasurementofcardiacnatriureticpeptites:areview.Clinical Chemistry,2004,50:3350.
- 14SingerDRJ,BucklyM,MacGregorG,etal.Raisedconcentrationsof plasmaatrialnatriureticpeptidesincardiactranplantrecipients.BrMed J,1986,293:13911392.
- 15KrauseDS,theiseMD,CollectorMI,etal.Multi organ,multi lineage engraftmentbyasinglebonemarrow derivedstemcell.Cell,2001,105:369377.