CAJ | 학술논문

目的观察扩张型心肌病患者经冠状动脉自体骨髓单个核细胞移植治疗的安全性及近中期疗效.方法 258例扩张型心肌病患者,传统治疗的基础上,根据是否行经冠状动脉自体骨髓单个核细胞移植分为移植组(n=71)和对照组(n=187).随访两组患者术前、术后1、3、6个月和1、2年超声心动图、动态心电图、6 min步行距离及心脏核素(SPECT)检查,记录年住院天数.结果移植组6 min步行距离术后1个月明显优于对照组[(345±76)m比(286±104)m,P<0.05].术后各随访时间点比较,移植组均优于对照组(P<0.05).术后1个月,移植组左心窜射血分数(LVEF)明显高于对照组[(41.5±9.4)%比(37.3±6.6)%,P<0.05].术后2年时移植组LVEF略高于对照组,差异无统计学意义[(43.6±6.3)%比(43.2±6.0)%,P>0.05].术后3个月移植组缺血心肌节段数较术前减少,且较对照组少[分别为(2.0±1.0)个比(3.1±1.4)个和(2.0±1.0)个比(3.1±1.2)个,P均<0.05],而坏死心肌节段数移植前后无明显改变.两组患者牛存率比较,差异无统计学意义(95.4%比94.9%,P>0.05).但移植组患者年住院天数明显少于对照组[(23.6±13.4)d比(33.0±14.0)d,P<0.05].结论经冠状动脉自体骨髓单个核细胞移植具有良好的安全性,能够提高扩张型心肌病患者的LVEF、增加6 min步行距离,减少年住院大数,且近期疗效显著,中期疗效与传统治疗相似.
목적 관찰확장형심기병환자경관상동맥자체골수단개핵세포이식치료적안전성급근중기료효.방법 258례확장형심기병환자,전통치료적기출상,근거시부행경관상동맥자체골수단개핵세포이식분위이식조(n=71)화대조조(n=187).수방량조환자술전、술후1、3、6개월화1、2년초성심동도、동태심전도、6 min보행거리급심장핵소(SPECT)검사,기록년주원천수.결과 이식조6 min보행거리술후1개월명현우우대조조[(345±76)m비(286±104)m,P<0.05].술후각수방시간점비교,이식조균우우대조조(P<0.05).술후1개월,이식조좌심찬사혈분수(LVEF)명현고우대조조[(41.5±9.4)%비(37.3±6.6)%,P<0.05].술후2년시이식조LVEF략고우대조조,차이무통계학의의[(43.6±6.3)%비(43.2±6.0)%,P>0.05].술후3개월이식조결혈심기절단수교술전감소,차교대조조소[분별위(2.0±1.0)개비(3.1±1.4)개화(2.0±1.0)개비(3.1±1.2)개,P균<0.05],이배사심기절단수이식전후무명현개변.량조환자우존솔비교,차이무통계학의의(95.4%비94.9%,P>0.05).단이식조환자년주원천수명현소우대조조[(23.6±13.4)d비(33.0±14.0)d,P<0.05].결론 경관상동맥자체골수단개핵세포이식구유량호적안전성,능구제고확장형심기병환자적LVEF、증가6 min보행거리,감소년주원대수,차근기료효현저,중기료효여전통치료상사.
Objective To evaluate the safety and effcacy of intracomnary autologous bone marrow mononuclear cells(BM-MNCs)transplantation in patients with dilated cardiomyopathy(DCM).Methods On top of standard therapy,DCM patients received BM-MNCs transplantation(n=71)or saline injection (n=187).The baseline clinical characteristics of two groups were comparable.Data on echocardiography,Holter,six-minute-walk test,cardiac SPECT and annual hospital days were obrained in all patients at baseline,1,3,6,12 and 24 months after transplantation.Results Six-minute-walk distance was significantly longer at one month[(345±76)m vs. (286±104)m,P<0.05]and thereafter(all P<0.05)in BM-MNCs group compared with saline group.Left ventricular ejection fraction(LVEF)at one month in BM-MNCs group was significantly higher compared with saline group[(41.5±9.4)%vs.(37.3± 6.6)%,P<0.05]and with pre-transplantation value[(41.5±9.4)%vs.(32.4±8.5)%,P<0.05] while LVEF was similar at 24 months after transplantation between the two groups[(43.6±6.3)%vs.(43.2±6.0)%.P>0.05 ].Three months after transplantation,the number of ischemic segments of BM-MNCs group wag significantly reduced compared with that of saline group(2.0±1.0 vs.3.1 ±1.4,P<0.05)and with baseline(2.0±1.0 vs.3.1±1.2,P<0.05)while the number of necrotic segments were similar in both groups during the follow-up.There were no significant difference in survival between two groups during 2 years follow·up(95.4%vs.94.9%,P>0.05)but the aflnual hospitalization days of BM-MNCs group was significantly lower than that of saline group[(23.6±13.4)d vs.(33.0±14.0)d,P>0.05].Conclusions Intracoronary transplantation of autologous BM.MNCs was safe and could increase LVEF and the six-minute-walk distance and reduce hospitalization days for patients witIl dilated cardiomyopathy.