聂颖,高炜,郭艳红,崔鸣,张永珍,郭丽君,郭静萱

• 1:北京大学第三医院心内科分子心血管学教育部重点实验室

摘要(Abstract)：

目的评价经冠状动脉内注射自体骨髓单个核细胞治疗前壁心肌梗死后心力衰竭的安全性。方法15例前壁心肌梗死患者接受经皮冠状动脉介入治疗(PCI)和药物治疗同时,进行冠状动脉内自体骨髓单个核细胞移植。细胞治疗前后测定血浆及骨髓中CD34+细胞含量;移植前、移植后24h和随访12个月时分别测定血浆红细胞(RBC)、血红蛋白(Hb)、网织红细胞、D-二聚体(D-Dimer)、N末端B型钠尿肽原(NT-proBNP)、超敏C反应蛋白(highsensitive-C reactive protein,hs-CRP)、肌钙蛋白T(troponinT,TnT)、心肌型肌酸激酶同工酶(CK-MB)、尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Cr)及尿酸(uricacid,UA)水平。入组及随访12个月时行动态心电图(Holter)评价心律失常发生情况,观察并记录移植前后及随访过程中发生的不良反应。结果分离后骨髓单个核细胞数量为(1.48±0.52)×109;CD34+细胞占1.28%±0.17%,数量为(18.57±9.14)×106。移植前循环血中CD34+细胞0.33%±0.12%,术后24h达峰值1.30%±0.35%,72h基本恢复至移植前水平0.53%±0.21%。移植后24h血浆NT-proBNP较移植前无显著性变化(1864.00±412.60μg/L比1864.00±369.70μg/L,P>0.05),随访12个月时较基线显著降低(701.05±154.60μg/L比1864.00±369.70μg/L,P<0.05)。移植后2、6、14、24h血浆TnT、CK-MB水平较移植前均无显著变化。与基线相比,移植后24h、12个月血浆RBC、Hb、网织红细胞、D-Dimer、hs-CRP及肝、肾功能均无显著变化。术后12个月随访未见恶性心律失常发生。结论经冠状动脉注射骨髓单个核细胞未引起微栓塞、炎症反应及心肌损伤,不诱发或加重心力衰竭,对血液系统、肝、肾功能及凝血功能无影响,长期随访未见与移植相关的严重不良反应。本研究提示经冠状动脉注射自体骨髓单个核细胞治疗方法是安全、可行的。

关键词(KeyWords)： 心肌梗死;造血干细胞移植;心力衰竭,充血性

Abstract:

Keywords:

基金项目(Foundation): 国家重点基础研究发展计划(973计划)(编号:2007cb512107)

作者(Author): 聂颖,高炜,郭艳红,崔鸣,张永珍,郭丽君,郭静萱

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