CAJ | 학술논문

目的:评价动员后自体外周血干细胞经冠状动脉移植治疗扩张型心肌病的远期临床疗效和安全性.方法:选择2004-03/2006-10武警广东省总队医院心内科收治的扩张型心肌病患者38例,男26例,女12例,年龄42～72岁,平均56岁.随机分为移植组(n=20)和对照组(n=18),两组均予常规药物治疗,其中移植组患者予重组人粒细胞集落刺激因子300 μg皮下注射,1次/d,进行自体外周血干细胞动员,第6天用血细胞分离机分离自体外周血干细胞,进行经皮经腔冠状动脉内移植;对照组:仅行常规药物治疗,未进行细胞移植.两组患者于移植前和移植后6,12个月分别检测血常规及生化指标(肝功能、肾功能、血糖、血脂、血尿酸、肌酸激酶、肌酸激酶同工酶和高敏C-反应蛋白)的变化;移植前和移植后12,24个月分别行超声心动图、动态心电图、6 min步行试验.比较两组生存率及心脏事件发生率,以患者死亡作为试验终点.结果:两组患者均获得随访,平均随访(18±6)个月,在随访12～24个月时移植组患者1例行二尖瓣置换,1例死亡,对照组2例死亡,均死于顽固性心衰.移植组患者移植后6,12个月血常规及生化各指标与移植前及对照组相比,差异均无显著性意义(P > 0.05).移植后12个月,移植组6 min步行路程较移植前明显增加,与对照组和自身移植前相比,差异均具有显著性意义(P < 0.05);超声检查显示左心室射血分数较移植前及对照组明显增加(P < 0.01).左心室舒张末内径也较移植前及对照组明显降低(P < 0.01).对照组的左心室射血分数及左心室舒张末内径虽然较12个月前有所改善,但差异无显著性意义(P > 0.05).随访至24个月,上述指标未见进一步改善,且有转差趋势.围移植期及移植后24个月随访中未见任何严重心律失常等不良反应发生.随访期间两组患者生存率无显著性意义.结论:采用动员后的自体外周血干细胞移植治疗扩张型心肌病安全、有效,近期可显著改善左心室收缩功能,但远期临床效果尚不肯定. 目的:評價動員後自體外週血榦細胞經冠狀動脈移植治療擴張型心肌病的遠期臨床療效和安全性.方法:選擇2004-03/2006-10武警廣東省總隊醫院心內科收治的擴張型心肌病患者38例,男26例,女12例,年齡42～72歲,平均56歲.隨機分為移植組(n=20)和對照組(n=18),兩組均予常規藥物治療,其中移植組患者予重組人粒細胞集落刺激因子300 μg皮下註射,1次/d,進行自體外週血榦細胞動員,第6天用血細胞分離機分離自體外週血榦細胞,進行經皮經腔冠狀動脈內移植;對照組:僅行常規藥物治療,未進行細胞移植.兩組患者于移植前和移植後6,12箇月分彆檢測血常規及生化指標(肝功能、腎功能、血糖、血脂、血尿痠、肌痠激酶、肌痠激酶同工酶和高敏C-反應蛋白)的變化;移植前和移植後12,24箇月分彆行超聲心動圖、動態心電圖、6 min步行試驗.比較兩組生存率及心髒事件髮生率,以患者死亡作為試驗終點.結果:兩組患者均穫得隨訪,平均隨訪(18±6)箇月,在隨訪12～24箇月時移植組患者1例行二尖瓣置換,1例死亡,對照組2例死亡,均死于頑固性心衰.移植組患者移植後6,12箇月血常規及生化各指標與移植前及對照組相比,差異均無顯著性意義(P > 0.05).移植後12箇月,移植組6 min步行路程較移植前明顯增加,與對照組和自身移植前相比,差異均具有顯著性意義(P < 0.05);超聲檢查顯示左心室射血分數較移植前及對照組明顯增加(P < 0.01).左心室舒張末內徑也較移植前及對照組明顯降低(P < 0.01).對照組的左心室射血分數及左心室舒張末內徑雖然較12箇月前有所改善,但差異無顯著性意義(P > 0.05).隨訪至24箇月,上述指標未見進一步改善,且有轉差趨勢.圍移植期及移植後24箇月隨訪中未見任何嚴重心律失常等不良反應髮生.隨訪期間兩組患者生存率無顯著性意義.結論:採用動員後的自體外週血榦細胞移植治療擴張型心肌病安全、有效,近期可顯著改善左心室收縮功能,但遠期臨床效果尚不肯定.
목적:평개동원후자체외주혈간세포경관상동맥이식치료확장형심기병적원기림상료효화안전성.방법:선택2004-03/2006-10무경광동성총대의원심내과수치적확장형심기병환자38례,남26례,녀12례,년령42～72세,평균56세.수궤분위이식조(n=20)화대조조(n=18),량조균여상규약물치료,기중이식조환자여중조인립세포집락자격인자300 μg피하주사,1차/d,진행자체외주혈간세포동원,제6천용혈세포분리궤분리자체외주혈간세포,진행경피경강관상동맥내이식;대조조:부행상규약물치료,미진행세포이식.량조환자우이식전화이식후6,12개월분별검측혈상규급생화지표(간공능、신공능、혈당、혈지、혈뇨산、기산격매、기산격매동공매화고민C-반응단백)적변화;이식전화이식후12,24개월분별행초성심동도、동태심전도、6 min보행시험.비교량조생존솔급심장사건발생솔,이환자사망작위시험종점.결과:량조환자균획득수방,평균수방(18±6)개월,재수방12～24개월시이식조환자1례행이첨판치환,1례사망,대조조2례사망,균사우완고성심쇠.이식조환자이식후6,12개월혈상규급생화각지표여이식전급대조조상비,차이균무현저성의의(P > 0.05).이식후12개월,이식조6 min보행로정교이식전명현증가,여대조조화자신이식전상비,차이균구유현저성의의(P < 0.05);초성검사현시좌심실사혈분수교이식전급대조조명현증가(P < 0.01).좌심실서장말내경야교이식전급대조조명현강저(P < 0.01).대조조적좌심실사혈분수급좌심실서장말내경수연교12개월전유소개선,단차이무현저성의의(P > 0.05).수방지24개월,상술지표미견진일보개선,차유전차추세.위이식기급이식후24개월수방중미견임하엄중심률실상등불량반응발생.수방기간량조환자생존솔무현저성의의.결론:채용동원후적자체외주혈간세포이식치료확장형심기병안전、유효,근기가현저개선좌심실수축공능,단원기림상효과상불긍정.
OBJECTIVE: To identify long-term outcomes and safety of transplantation of autologous peripheral blood stem cells (PBSC) for treating dilated cardiomyopathy.METHODS: A total of 38 cases with dilated cardiomyopathy received treatment at the Department of Cardiology, Guangdong General Hospital of Chinese People's Armed Police Forces, were selected, including 26 males and 12 females, aged 42-72 years, mean aged 56 years. Based on given standard therapy, 38 patients divided randomly into the transplantation group (n=20) and the control group (n=18). Patients in the transplantation group were received recombinant human granulocyte colony-stimulating factor (rhG-CSF) 300 ug/d once per day for 5 days to mobilize stem cells. At day 6, PBSC were collected with blood-cells separator and were transplanted through intracoroary way. The routine medication was performed in the control group. Blood routine test, hepatic function, renal function, glucose, triglyeride (TG), cholesterol, low density cholesterol (C-LDL), high density cholest- erol (C-HDL), uric acid (UA), creatine kinase (CK), isoenzyme of creatine kinase (CK-MB) and high sensitive C-reactive protein (hsCRP) were measured before and at months 6 and 12 after transplantation. All patients also received ultrasonic echocardiography, ECG Holter monitor and six-minute-walk test before and at 12 and 24 months after the procedure. Survival rate and incidence rate of heart incidents were compared. The study end-point was death from any cause. RESULTS: All patients received a 12-24 month follow-up with mean (18±6) months. One patient in the transplantation group received mitral valve replacement. One patient of the transplantation group and 2 of the control group died due to refractory heart failure. The blood routine test and biochemical indicators of the transplantation group had no significant differences among 6 months and 12 months after transplantation compared with control and pre-transplantation (P > 0.05). Six-minute-walking distance in the transplantation group significantly increased at 12 months after transplantation than pre-transplantation level, which was also higher than that of control patients (P < 0.05). The left ventricular ejection fraction (LVEF) was increased (P < 0.01). The left ventricular diastolic diameter (LVDd) decreased significantly in the transplantation group (P < 0.01). In the control group, improvement in LVEF and LVDd were observed, but there was no significant difference (P > 0.05). After 24 months of follow-up, the above-mentioned indexes had not improved in the transplantation group without significant differences. No malignant arrhythmias and severe side effects could be observed around transplantation and during 24 months follow-up. Survival was similar between the two groups during 24 months follow. CONCLUSION: Transplantation of mobilized autologous PBSC might be a safe and effective method for the treatment of dilated cardiomyopathy, which may improve the ventricular systolic function in a short-term, however, the long-term effects still uncertain.