中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2007年
29期
5850-5853
,共4页
周霖%杨永平%王春平%马威%王华明%马雪梅%冯永毅%苏淑惠%王福生%安林静%齐冬颖%陆荫英%陈艳%贾红军
週霖%楊永平%王春平%馬威%王華明%馬雪梅%馮永毅%囌淑惠%王福生%安林靜%齊鼕穎%陸蔭英%陳豔%賈紅軍
주림%양영평%왕춘평%마위%왕화명%마설매%풍영의%소숙혜%왕복생%안림정%제동영%륙음영%진염%가홍군
乙型肝炎%肝衰竭%肝细胞移植%随访
乙型肝炎%肝衰竭%肝細胞移植%隨訪
을형간염%간쇠갈%간세포이식%수방
背景:近年来发展的肝细胞移植作为肝衰竭及遗传性代谢性肝脏疾病的一种治疗措施日益受到重视.目的:随访2年评估1例人肝细胞移植治疗慢性乙型重型肝炎患者的疗效.设计:病例报告,随访2年.单位:解放军第三○二医院感染九科及生物工程研究室.对象:纳入解放军第三○二医院感染住院的慢性重型肝炎患者1例.经实验室检查等确诊.用于移植的肝脏细胞由1名24岁供体提供,该供体生前签署过肝脏捐赠协议,且肝脏健康.方法:于2004-12在解放军第三○二医院放射科完成肝细胞体内移植.分离肝脏,获得人原代肝细胞并冷冻保存,复苏后经股动脉插管移植到受体脾脏,观察治疗前后患者临床症状及血液生化指标改变及脾脏核磁共振信号的改变.患者术后每半年复诊检测1次肝功能、凝血功能、B超及胃镜检查、MRI,随访2年.主要观察指标:患者肝功能、凝血功能、影像学指标、免疫学指标、并发症和排斥反应发生情况.结果:①人肝脏可获取(1～2)×1010肝细胞,复苏后肝细胞存活率在60%以上,移植的肝细胞数为2×109个.②移植后2个月,患者临床症状明显改善,血胆红素、天门冬氨酸氨基转移酶明显降低,凝血酶原活动度明显升高.移植20个月后MRI提示脾脏内可见肝细胞信号.术后2年患者血总胆红素20 μmot/L,直接胆红素7μmol/L,丙氨酸氨基转移酶416.75 nka/L,天门冬氨酸氨基转移酶533.44 nkat/L,白蛋白37g/L,凝血酶原活动度90%,较术前明显改善(474.5,340.3 μmol/L,400.08,1 200.24 nkat/L,38 g/L,25%).患者可从事正常一般家务活动及轻体力工作.未出现腹水及肝功能衰竭等并发症,未出现移植排斥反应.患者多次复查B超及胃镜均提示肝硬化及食道静脉曲张有进一步加重的趋势,曾2次因食道静脉曲张破裂出血而住院治疗.结论:肝细胞体内移植可改善肝功能,且未见移植排斥反应,但不能解决门静脉高压.
揹景:近年來髮展的肝細胞移植作為肝衰竭及遺傳性代謝性肝髒疾病的一種治療措施日益受到重視.目的:隨訪2年評估1例人肝細胞移植治療慢性乙型重型肝炎患者的療效.設計:病例報告,隨訪2年.單位:解放軍第三○二醫院感染九科及生物工程研究室.對象:納入解放軍第三○二醫院感染住院的慢性重型肝炎患者1例.經實驗室檢查等確診.用于移植的肝髒細胞由1名24歲供體提供,該供體生前籤署過肝髒捐贈協議,且肝髒健康.方法:于2004-12在解放軍第三○二醫院放射科完成肝細胞體內移植.分離肝髒,穫得人原代肝細胞併冷凍保存,複囌後經股動脈插管移植到受體脾髒,觀察治療前後患者臨床癥狀及血液生化指標改變及脾髒覈磁共振信號的改變.患者術後每半年複診檢測1次肝功能、凝血功能、B超及胃鏡檢查、MRI,隨訪2年.主要觀察指標:患者肝功能、凝血功能、影像學指標、免疫學指標、併髮癥和排斥反應髮生情況.結果:①人肝髒可穫取(1～2)×1010肝細胞,複囌後肝細胞存活率在60%以上,移植的肝細胞數為2×109箇.②移植後2箇月,患者臨床癥狀明顯改善,血膽紅素、天門鼕氨痠氨基轉移酶明顯降低,凝血酶原活動度明顯升高.移植20箇月後MRI提示脾髒內可見肝細胞信號.術後2年患者血總膽紅素20 μmot/L,直接膽紅素7μmol/L,丙氨痠氨基轉移酶416.75 nka/L,天門鼕氨痠氨基轉移酶533.44 nkat/L,白蛋白37g/L,凝血酶原活動度90%,較術前明顯改善(474.5,340.3 μmol/L,400.08,1 200.24 nkat/L,38 g/L,25%).患者可從事正常一般傢務活動及輕體力工作.未齣現腹水及肝功能衰竭等併髮癥,未齣現移植排斥反應.患者多次複查B超及胃鏡均提示肝硬化及食道靜脈麯張有進一步加重的趨勢,曾2次因食道靜脈麯張破裂齣血而住院治療.結論:肝細胞體內移植可改善肝功能,且未見移植排斥反應,但不能解決門靜脈高壓.
배경:근년래발전적간세포이식작위간쇠갈급유전성대사성간장질병적일충치료조시일익수도중시.목적:수방2년평고1례인간세포이식치료만성을형중형간염환자적료효.설계:병례보고,수방2년.단위:해방군제삼○이의원감염구과급생물공정연구실.대상:납입해방군제삼○이의원감염주원적만성중형간염환자1례.경실험실검사등학진.용우이식적간장세포유1명24세공체제공,해공체생전첨서과간장연증협의,차간장건강.방법:우2004-12재해방군제삼○이의원방사과완성간세포체내이식.분리간장,획득인원대간세포병냉동보존,복소후경고동맥삽관이식도수체비장,관찰치료전후환자림상증상급혈액생화지표개변급비장핵자공진신호적개변.환자술후매반년복진검측1차간공능、응혈공능、B초급위경검사、MRI,수방2년.주요관찰지표:환자간공능、응혈공능、영상학지표、면역학지표、병발증화배척반응발생정황.결과:①인간장가획취(1～2)×1010간세포,복소후간세포존활솔재60%이상,이식적간세포수위2×109개.②이식후2개월,환자림상증상명현개선,혈담홍소、천문동안산안기전이매명현강저,응혈매원활동도명현승고.이식20개월후MRI제시비장내가견간세포신호.술후2년환자혈총담홍소20 μmot/L,직접담홍소7μmol/L,병안산안기전이매416.75 nka/L,천문동안산안기전이매533.44 nkat/L,백단백37g/L,응혈매원활동도90%,교술전명현개선(474.5,340.3 μmol/L,400.08,1 200.24 nkat/L,38 g/L,25%).환자가종사정상일반가무활동급경체력공작.미출현복수급간공능쇠갈등병발증,미출현이식배척반응.환자다차복사B초급위경균제시간경화급식도정맥곡장유진일보가중적추세,증2차인식도정맥곡장파렬출혈이주원치료.결론:간세포체내이식가개선간공능,차미견이식배척반응,단불능해결문정맥고압.
BACKGROUND:Hepatocyte transplantation has attracted more and more attention as a therapeutic measure for liver failure and genetic metabolic liver diseases.OBJECTIVE:TO evaluate the efficacy and safety of human hepatocyte transplantation in treating hepatitis B related liver failure in one case by a 2-year follow-up.DESIGN:A case-report of 2-year follow-up.SETTING:No.9 Department of Infectious Diseases,Bioengineering Research Room,the 302 Hospital of Chinese PLA.PARTICI PANT:One inpatient with hepatitis B related liver failure was selected from the 302 Hospital of Chinese PLA.and she was diagnosed according the laboratory tests.The transplanted hepatocytes were originated frOm the healthy liver of a 24-year-old man,who had signed the protocol for liver donation before death.METHODS:The hepatocyte transplantation was completed in the Department of Radiology,the 302 Hospital of Chinese PLA in December 2004.Liver was isolated to obtain human primary hepatocytes, and then cryopreserved.The hepatocytes were transplanted into recipient spleen via femoral vein after resuscitation.The clinical symptoms,changes of blood biochemical indexes,and changes of spleen MRI signals were observed before and after operation.The patient was reexamined every half a year after operation, including liver function, blood coagulation function,B-mode ultrasonography,gastroscopy and MRI,and she was followed up for 2 years. MAIN OUTCOME MEASURES:Liver function,blood coagulation function, imaging indexes, immunological indexes,complication and rejection.RESULTS:①Totally(1-2)×1010 hepatocytes were harvested,and the viability of rewarmed hepatocytes was 60%,and finally 2×109 hepatocytes were transplanted.②Two months later,the clinical symptoms of the recipient were obviously ameliorated,and serum bilirubin and aspartate aminotransferase(AST)were obviously decreased,while prothrombin activity was markedly increased.20 months later,the MRI results showed that there was hepatocyte image in spleen.Two years after operation.the total bilirubin level was 20 μmol/L,direct bilirubin level was 7 μmol/L, alanine aminotransferase was 416.75 nkat/L,AST was 533.44 nkat/L,albumin was 37 g/L,prothrombin activity was 90%,which were all obviously ameliorated as compared with those before operation(474.5 μmol/L,340.3 μmol/L,400.08 nkat/L,1 200.24 nkat/L,38 g/L,25%).The patient left the hospital 2 months later and could do light-burdened job.No complications of hydroperitonia and liver function failure, etc.were observed,and no rejection occurred.Several reexaminations by B-mode ultrasonography all indicated the further aggravations of liver cirrhosis and esophageal varices.She was admitted to hospital for twice because of esophageal varices bleeding,and cured by endoscopic variceal sclerosis therapy.CONCLUSION:Hepatocyte transplantation can ameliorate liver function without rejection,but it cannot relieve portal hypertension.
