CAJ | 학술논문

背景:有实验表明移植心肌梗死区的骨髓干细胞可以定向分化为具有正常生理功能的心肌细胞并可促进新生血管形成,达到修复梗死心肌并改善受损的心脏功能.目的:观察经皮冠状动脉内移植自体骨髓干细胞治疗急性心肌梗死的近期临床疗效.设计:自身前后对照.单位:湘潭市中心医院心内科.对象:选择2004-06/2006-12在湘潭市中心医院心内科收治的27例急性心肌梗死患者,男16例,女11例,年龄34～74岁,平均(61±9)岁;纳入标准:①入选发病超过6 h.②心电图、酶学动态的改变符合急性心肌梗死.③心功能在Ⅰ～Ⅱ级之间.④发病后急诊完成经皮冠状动脉介入治疗且梗死相关血管血流恢复至TIMI 3级.所有患者均签署了知情同意书.方法:手术过程:所有患者均于发病后行急诊冠状动脉介入治疗,1周后经皮腔导管技术建立梗死相关动脉通道,用指引导丝将微灌注导管送入支架内后,将分离的骨髓干细胞悬液经微导管中心腔内注入梗死血管远端.术后评价:移植前、后分别行24 h动态心电图评估;移植前和移植后6,12个月检测患者左室射血分数、心肌灌注缺损指数.术后6,12个月随访观察恢复及并发症情况.主要观察指标:①左室射血分数、心肌灌注缺损指数.②24 h动态心电图评估结果.③术后并发症情况.结果:纳入患者27例均进入结果分析.①左室射血分数、心肌灌注缺损指数:术后6,12个月左室射血分数均高于移植前,差异有统计学意义(P＜0.05),心肌灌注缺损指数均低于移植前,差异有统计学意义(P＜0.05).②动态心电图结果:患者均无新的心律失常类型出现,无心律失常的增多及恶性心律失常的出现.③随访评估:经冠状动脉内移植术中无并发症发生,无患者支架内狭窄.结论:经皮冠状动脉内移植骨髓干细胞治疗急性心肌梗死安全可行,术后能改善心功能.
배경:유실험표명이식심기경사구적골수간세포가이정향분화위구유정상생리공능적심기세포병가촉진신생혈관형성,체도수복경사심기병개선수손적심장공능.목적:관찰경피관상동맥내이식자체골수간세포치료급성심기경사적근기림상료효.설계:자신전후대조.단위:상담시중심의원심내과.대상:선택2004-06/2006-12재상담시중심의원심내과수치적27례급성심기경사환자,남16례,녀11례,년령34～74세,평균(61±9)세;납입표준:①입선발병초과6 h.②심전도、매학동태적개변부합급성심기경사.③심공능재Ⅰ～Ⅱ급지간.④발병후급진완성경피관상동맥개입치료차경사상관혈관혈류회복지TIMI 3급.소유환자균첨서료지정동의서.방법:수술과정:소유환자균우발병후행급진관상동맥개입치료,1주후경피강도관기술건립경사상관동맥통도,용지인도사장미관주도관송입지가내후,장분리적골수간세포현액경미도관중심강내주입경사혈관원단.술후평개:이식전、후분별행24 h동태심전도평고;이식전화이식후6,12개월검측환자좌실사혈분수、심기관주결손지수.술후6,12개월수방관찰회복급병발증정황.주요관찰지표:①좌실사혈분수、심기관주결손지수.②24 h동태심전도평고결과.③술후병발증정황.결과:납입환자27례균진입결과분석.①좌실사혈분수、심기관주결손지수:술후6,12개월좌실사혈분수균고우이식전,차이유통계학의의(P＜0.05),심기관주결손지수균저우이식전,차이유통계학의의(P＜0.05).②동태심전도결과:환자균무신적심률실상류형출현,무심률실상적증다급악성심률실상적출현.③수방평고:경관상동맥내이식술중무병발증발생,무환자지가내협착.결론:경피관상동맥내이식골수간세포치료급성심기경사안전가행,술후능개선심공능.
BACKGROUND: Recent researches demonstrate that transplantation of bone marrow stem cells in the area of myocardial infarction can directionally differentiate into myocardial cells having normal physiological function and can promote newborn vascularization so as to repair infarction myocardium and improve injured cardiac function.OBJECTIVE: To observe short-term clinical effect of autologous bone marrow stem cell transplantation (ABMSCT) in percutaneous coronary artery on the treatment of acute myocardial infarction.DESIGN: Self-control study.SETTING: Department of Cardiology, Xiangtan Central Hospital.PARTICIPANTS: A total of 27 patients with acute myocardial infarction, including 16 males and 11 females, were selected from Department of Cardiology, Xiangtan Central Hospital from June 2004 to December 2006. Their ages coronary artery was finished after onset emergently; in addition, blood flow of infraction related vessels recovered to grade TIMI3. All patients provided the confirmed consent.METHODS: Operative procedure: All patients were performed with emergently interventional therapy of coronary artery after onset of acute myocardial infarction. One week later, percutaneous cavity tube technique was used to establish infarction related arterial pathway, and guiding filament was used to send micro-perfusion tube into stents. And then,separated bone marrow stem cell suspension was poured through central cavity of micro-tube into the distal end of infarction vessels. Operative evaluation: Dynamic electrocardiogram was evaluated for 24 hours before and after transplantation; in addition, left ventricular ejection fraction and myocardial perfusion defect scores were detected before and at 6 and 12 months after transplantation; otherwise, recovery state and complication were observed in follow up at 6 and 12 months after operation.defect scores: At 6 and 12 months after operation, left ventricular ejection fraction was higher than that before transplantation, and there was significant difference before and after transplantation (P＜0.05). While, myocardial perfusion defect scores were lower than those before transplantation, and there was significant difference before and arrhythmia were not found out, cardiac arrhythmia was not increased, and cardiac arrhythmia combining with malignancy not have any complications and in-stent constriction after operation.