CAJ | 학술논문

目的比较经冠状动脉内移植单个核干细胞(MNC)和间充质干细胞(MSC)治疗扩张型心肌病(DCM)的临床疗效.方法 53例左心室射血分数＜40％的DCM患者随机分成MNC移植组(n=16)、MSC移植组(n=17)和对照组(n=20),均通过大腔导管于冠状动脉内分别注入等量MNC、MSC和生理盐水.随访3个月并记录不同时期左心室舒张末径、左心室射血分数和心肌灌注缺损面积百分比等指标,同时记录恶性心血管事件的发生情况.结果 (1)术后1个月时,两移植组患者左心室射血分数均较术前明显增加(P均＜0.05),但仅MSC移植组显著高于对照组(P＜0.05).各组患者的左心室舒张末径和心肌灌注缺损面积均较术前减小,但各组间差异均无统计学意义.(2)术后3个月时,两移植组左心室射血分数均较术前明显增大(P均＜0.05),亦均显著大于对照组(P均＜0.05),两移植组间差异无统计学意义.两移植组患者左心室舒张末径和心肌灌注缺损面积均较术前明显减小(P均＜0.05),但仅MSC移植组心肌灌注缺损面积明显小于对照组(P＜0.05).(3)恶性心血管事件发生率各组间差异无统计学意义.结论干细胞移植治疗DCM安全、有效,MSC移植的疗效相对于MNC移植而言优势并不明显.
목적 비교경관상동맥내이식단개핵간세포(MNC)화간충질간세포(MSC)치료확장형심기병(DCM)적림상료효.방법 53례좌심실사혈분수＜40％적DCM환자수궤분성MNC이식조(n=16)、MSC이식조(n=17)화대조조(n=20),균통과대강도관우관상동맥내분별주입등량MNC、MSC화생리염수.수방3개월병기록불동시기좌심실서장말경、좌심실사혈분수화심기관주결손면적백분비등지표,동시기록악성심혈관사건적발생정황.결과 (1)술후1개월시,량이식조환자좌심실사혈분수균교술전명현증가(P균＜0.05),단부MSC이식조현저고우대조조(P＜0.05).각조환자적좌심실서장말경화심기관주결손면적균교술전감소,단각조간차이균무통계학의의.(2)술후3개월시,량이식조좌심실사혈분수균교술전명현증대(P균＜0.05),역균현저대우대조조(P균＜0.05),량이식조간차이무통계학의의.량이식조환자좌심실서장말경화심기관주결손면적균교술전명현감소(P균＜0.05),단부MSC이식조심기관주결손면적명현소우대조조(P＜0.05).(3)악성심혈관사건발생솔각조간차이무통계학의의.결론 간세포이식치료DCM안전、유효,MSC이식적료효상대우MNC이식이언우세병불명현.
Objective To compare the effects of intracoronary infusion of mononuclear stem cells (MNCs) or mesenchymal stem cells (MSCs) in patients with dilated cardiomyopathy (DCM).Methods DCM patients with left ventricular ejection fraction ( LVEF ) ＜ 40％ were randomized to intracoronary infusion of MNCs [ (5.1 ± 2.0) × 108,n =16] or MSCs [ (4.9 ± 1.7 ) × 108,n =17 ] or equal volume normal saline ( n =20 ) through the guiding catheter. Changes of left ventricular end-diastolic diameter (LVEDd),LVEF and myocardium perfusion defects were assessed before and at (30 ±3) days and (90 ± 7) days after the procedure.Malignant cardiovascular events were also recorded.Results ( 1 ) One month after the procedure,LVEF in transplantation groups significantly increased compared to before procedure ( all P ＜0.05),and significant increase of LVEF was observed only in MSCs transplantation group compared to control group ( P ＜ 0.05 ).However,absolute changes of LVEDd and perfusion defects of myocardium were similar among and within groups (P ＞ 0.05 ).(2)Gomparing with before procedure and control group,LVEF in transplantation groups increased significantly in three months after the procedure (P ＜ 0.05 ),but there were no significant differences between transplantation groups ( P ＞ 0.05 ).LVEDd and myocardium perfusion defects in transplantation groups improved significantly compared with that of before procedure (P ＜0.05 ),while significant decrease of myocardium perfusion defects was only observed in patients treated with MSCs compared with control group at three months after procedure ( P ＜ 0.05 ). ( 3 ) There were no significant differences in major cardiovascular events between transplantation group and control during followup ( P ＞ 0.05).Conclusions Intracoronary bone marrow stem cells transplantation is safe and effective for DCM patients while the efficacy of MSCs and MNCs transplantation is comparable.