CAJ | 학술논문

背景:有动物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,改善受损的心脏功能.目的:观察自体骨髓干细胞移植对缺血性心肌病心力衰竭患者近期心功能的影响.设计:自身前后对照.单位:湘潭市中心医院心内科.对象:选择2004-03/2006-01在湘潭市中心医院心内科收治的21例缺血性心肌病患者,男13例,女8例,平均(64±6)岁,纳入标准:既往至少患过1次心肌梗死,心脏B超提示心腔扩大,支架置入前存在明显的心功能不全或心绞痛且反复住院,均已成功完成经皮腔冠状动脉介入治疗且梗死血管血流恢复至TIMl3级达3月以上,尚存在不同程度心功能不全.冠状动脉造影显示冠脉内支架均无狭窄.患者均对手术项目知情同意.方法:患者入院后在常规药物治疗的基础上予骨髓干细胞移植,经皮腔导管技术建立梗死相关动脉通道,利用球囊封闭梗死相关动脉通道,并将分离的骨髓干细胞悬液经导管中心腔注入梗死相关动脉通道.①分别于移植前和移植后6月测量左室射血分数、左室舒张末内径.②移植前及移植后6月在未服抗心律失常药物的前提下,分别行24 h动态心电图评估.③对患者移植前及移植6月后临床心功能分级评定,采用NYHA分级方法,Ⅰ～Ⅳ级:级数越高,症状越严重.④观察术后不良事件和副反应.主要观察指标:①移植前和移植后6月测左室射血分数、左室舒张末内径.②24 h动态心电图评估结果.③临床心功能分级评定结果.④术后不良事件和副反应.结果:纳入21例患者全部进入结果分析.①骨髓干细胞移植6个月后患者左室射血分数大于移植前[(54.4±6.2)%,(44.6±6.4)%,t=-5.946,P＜0.01],左室舒张末内径小于移植前[(54.6±4.2),(60.2±4.4)mm,t=5.306,P＜0.01].②患者未出现新的心律失常类型,亦无恶性心律失常增多.③骨髓干细胞移植6月后,心功能Ⅲ、Ⅳ级患者共9例,而移植前为18例.④移植术中、术后均安全,无因胸痛复查冠脉造影显示支架内狭窄患者,未出现死亡病例.结论:经皮腔冠状动脉内移植骨髓干细胞治疗缺血性心肌病可行,术后能提高左室射血分数,心功能改善. 揹景:有動物實驗錶明移植心肌梗死區的骨髓榦細胞可以定嚮分化為具有正常生理功能的心肌細胞併可促進新生血管形成,達到脩複梗死心肌,改善受損的心髒功能.目的:觀察自體骨髓榦細胞移植對缺血性心肌病心力衰竭患者近期心功能的影響.設計:自身前後對照.單位:湘潭市中心醫院心內科.對象:選擇2004-03/2006-01在湘潭市中心醫院心內科收治的21例缺血性心肌病患者,男13例,女8例,平均(64±6)歲,納入標準:既往至少患過1次心肌梗死,心髒B超提示心腔擴大,支架置入前存在明顯的心功能不全或心絞痛且反複住院,均已成功完成經皮腔冠狀動脈介入治療且梗死血管血流恢複至TIMl3級達3月以上,尚存在不同程度心功能不全.冠狀動脈造影顯示冠脈內支架均無狹窄.患者均對手術項目知情同意.方法:患者入院後在常規藥物治療的基礎上予骨髓榦細胞移植,經皮腔導管技術建立梗死相關動脈通道,利用毬囊封閉梗死相關動脈通道,併將分離的骨髓榦細胞懸液經導管中心腔註入梗死相關動脈通道.①分彆于移植前和移植後6月測量左室射血分數、左室舒張末內徑.②移植前及移植後6月在未服抗心律失常藥物的前提下,分彆行24 h動態心電圖評估.③對患者移植前及移植6月後臨床心功能分級評定,採用NYHA分級方法,Ⅰ～Ⅳ級:級數越高,癥狀越嚴重.④觀察術後不良事件和副反應.主要觀察指標:①移植前和移植後6月測左室射血分數、左室舒張末內徑.②24 h動態心電圖評估結果.③臨床心功能分級評定結果.④術後不良事件和副反應.結果:納入21例患者全部進入結果分析.①骨髓榦細胞移植6箇月後患者左室射血分數大于移植前[(54.4±6.2)%,(44.6±6.4)%,t=-5.946,P＜0.01],左室舒張末內徑小于移植前[(54.6±4.2),(60.2±4.4)mm,t=5.306,P＜0.01].②患者未齣現新的心律失常類型,亦無噁性心律失常增多.③骨髓榦細胞移植6月後,心功能Ⅲ、Ⅳ級患者共9例,而移植前為18例.④移植術中、術後均安全,無因胸痛複查冠脈造影顯示支架內狹窄患者,未齣現死亡病例.結論:經皮腔冠狀動脈內移植骨髓榦細胞治療缺血性心肌病可行,術後能提高左室射血分數,心功能改善.
배경:유동물실험표명이식심기경사구적골수간세포가이정향분화위구유정상생리공능적심기세포병가촉진신생혈관형성,체도수복경사심기,개선수손적심장공능.목적:관찰자체골수간세포이식대결혈성심기병심력쇠갈환자근기심공능적영향.설계:자신전후대조.단위:상담시중심의원심내과.대상:선택2004-03/2006-01재상담시중심의원심내과수치적21례결혈성심기병환자,남13례,녀8례,평균(64±6)세,납입표준:기왕지소환과1차심기경사,심장B초제시심강확대,지가치입전존재명현적심공능불전혹심교통차반복주원,균이성공완성경피강관상동맥개입치료차경사혈관혈류회복지TIMl3급체3월이상,상존재불동정도심공능불전.관상동맥조영현시관맥내지가균무협착.환자균대수술항목지정동의.방법:환자입원후재상규약물치료적기출상여골수간세포이식,경피강도관기술건립경사상관동맥통도,이용구낭봉폐경사상관동맥통도,병장분리적골수간세포현액경도관중심강주입경사상관동맥통도.①분별우이식전화이식후6월측량좌실사혈분수、좌실서장말내경.②이식전급이식후6월재미복항심률실상약물적전제하,분별행24 h동태심전도평고.③대환자이식전급이식6월후림상심공능분급평정,채용NYHA분급방법,Ⅰ～Ⅳ급:급수월고,증상월엄중.④관찰술후불량사건화부반응.주요관찰지표:①이식전화이식후6월측좌실사혈분수、좌실서장말내경.②24 h동태심전도평고결과.③림상심공능분급평정결과.④술후불량사건화부반응.결과:납입21례환자전부진입결과분석.①골수간세포이식6개월후환자좌실사혈분수대우이식전[(54.4±6.2)%,(44.6±6.4)%,t=-5.946,P＜0.01],좌실서장말내경소우이식전[(54.6±4.2),(60.2±4.4)mm,t=5.306,P＜0.01].②환자미출현신적심률실상류형,역무악성심률실상증다.③골수간세포이식6월후,심공능Ⅲ、Ⅳ급환자공9례,이이식전위18례.④이식술중、술후균안전,무인흉통복사관맥조영현시지가내협착환자,미출현사망병례.결론:경피강관상동맥내이식골수간세포치료결혈성심기병가행,술후능제고좌실사혈분수,심공능개선.
BACKGROUND: Animal experiments have demonstrated that transplanted bone marrow stem cells (BMSCs) in the myocardial infarction region can directionally differentiate into myocardial cells with normal physiological function and promote neovascularization. Clinical studies have also showed that the cardiac function can be improved in myocardial infarction and cardiomyopathy patients after stem cell transplantation.OBJECTIVE: To observe the effect of autologous BMSCs transplantation on short-term cardiac function of patients with heart failure of ischemic cardiomyopathy.DESIGN: Self-control study.SETTING: Department of Cardiology, Xiangtan Central Hospital.PARTICIPANTS: Twenty-one patients with ischemic cardiomyopathy, including 13 males and 8 females, aged (64±6)years, who received treatment in the Department of Cardiology, Xiangtan Central Hospital of Hunan Province from March 2004 to January 2006 were retrieved. Inclusive criteria: with previous myocardial infarction at least once, B-mode ultrasonic cardiac examination showed that cardiac chamber was expanded, obvious cardiac inadequacy or stenocardia existed before stent implantation and hospitalized repeatedly, underwent percutaneous coronary artery intervention for restoring blood flow of infarcted vessel to TIMI3 degree over 3 months, but cardiac inadequacy existed to different degrees. Coronary arteriongraphy showed that no stenosis was found in the stent implanted in the coronary artery.Informed consents were obtained from all the patients.METHODS: After admission, all the patients received BMSCs transplantation based on routine drug treatment.Infarction-related arterial passage was established by percutaneous transluminal catheter technique and occluded by balloon. Isolated bone marrow stem cell suspension was injected into infarction-related arterial passage through the central cavity of catheter. ① Left ventricular ejection fractions (LVEF) and left ventricular end-diastolic diameter(LVDd)were measured before and 6 months after transplantation. ② 24-hour dynamic electrocardiogram evaluation was conducted before and 6 months after transplantation under the precondition of not taking antiarrhythmic drugs. ③Clinical cardiac functional grading was conducted before and 6 months after transplantation by NYHA grading method: Grade Ⅰto Ⅳ: the higher grade, the severer symptom. ④ Adverse events and side effects were observed after operation.MAIN OUTCOME MEASURES: ① LVEF and LVDd were measured before and 6 months after transplantation. ②24-hour dynamic electrocardiogram evaluation results. ③ Clinical cardiac functional grading evaluation results. ④ Post-operative adverse events and side effects.RESULTS: All the involved 21 patients participated in the result analysis. ①The LVEF of patients 6 months after transplantation of BMSCs was more than that before transplantation [(54.4±6.2)％, (44.6±6.4)％,t = -5.946, P＜ 0.01], and LVDd of patients 6 months after transplantation was smaller than that before transplantation [(54.6±4.2), (60.2±4.4) mm,t = 5.306, P ＜ 0.01]. ② No new arrhythmic types appeared, and case of malignant serious cardiac arrhythmias were not increased. ③ Six months after transplantation of BMSCs, there were totally 9 patients with cardiac function of grade Ⅲ and Ⅳ, while there were 18 patients before transplantation. ④ The whole transplantation was safe.No patients were found to undergo re-examination of coronary arteriongraphy, which showed stent necrosis, due to chest pain, and no dead cases were either found.CONCLUSION: It is feasible to treat ischemic cardiomyopathy by percutaneous coronary transplantation of BMSCs,which can boost LVEF and improve cardiac function after transplantation.