CAJ | 학술논문

背景：很多动物实验和临床试验均证实，干细胞移植可改善心脏功能，减少心室扩张及心室重构，在治疗心肌梗死合并心衰方面已经表现出传统治疗方法所无可比拟的优越性。 　　目的：观察单次自体外周血干细胞移植在急性心肌梗死后心衰患者中的临床疗效。方法：选择2005年8月至2006年9月收治的急性ST段抬高心肌梗死合并心衰患者23例，将入选者分成两组，细胞移植组11例，对照组12例，均急诊行冠状动脉造影及药物洗脱支架置入(PCI)。细胞移植组于支架置入后5 d，采集经粒细胞集落刺激因子动员5 d的外周血干细胞(CD34+细胞，大约1×108)，用冠脉造影注射法注入梗死相关血管。细胞移植后随访2年，观察患者心功能变化及不良反应。 　　结果与结论：细胞移植组移植前与随访至6个月时相比，心功能明显改善(P <0.05)，左室射血分数提高(6.2±0.2)%，左室舒张末期容积减少(4.7±2.9) mm，而移植后随访至1年、2年时结果并无明显区别(P >0.05)，未发现细胞移植的不良反应。对照组随访至6个月时，左室射血分数下降(0.5±0.1)%，左室舒张末期容积增大(0.4±0.3) mm，并且逐年恶化。证实经皮经冠状动脉内自体外周血干细胞单次移植6个月时，能明显改善急性心肌梗死患者的左室功能，减小左室容量，阻止或延缓左室重构，且安全有效，但随访至2年，心功能没有得到进一步的改善。
배경：흔다동물실험화림상시험균증실，간세포이식가개선심장공능，감소심실확장급심실중구，재치료심기경사합병심쇠방면이경표현출전통치료방법소무가비의적우월성。 　　목적：관찰단차자체외주혈간세포이식재급성심기경사후심쇠환자중적림상료효。방법：선택2005년8월지2006년9월수치적급성ST단태고심기경사합병심쇠환자23례，장입선자분성량조，세포이식조11례，대조조12례，균급진행관상동맥조영급약물세탈지가치입(PCI)。세포이식조우지가치입후5 d，채집경립세포집락자격인자동원5 d적외주혈간세포(CD34+세포，대약1×108)，용관맥조영주사법주입경사상관혈관。세포이식후수방2년，관찰환자심공능변화급불량반응。 　　결과여결론：세포이식조이식전여수방지6개월시상비，심공능명현개선(P <0.05)，좌실사혈분수제고(6.2±0.2)%，좌실서장말기용적감소(4.7±2.9) mm，이이식후수방지1년、2년시결과병무명현구별(P >0.05)，미발현세포이식적불량반응。대조조수방지6개월시，좌실사혈분수하강(0.5±0.1)%，좌실서장말기용적증대(0.4±0.3) mm，병차축년악화。증실경피경관상동맥내자체외주혈간세포단차이식6개월시，능명현개선급성심기경사환자적좌실공능，감소좌실용량，조지혹연완좌실중구，차안전유효，단수방지2년，심공능몰유득도진일보적개선。
BACKGROUND: Many animal experiments and clinical trials have demonstrated that stem celltransplantation can improve heart function and reduce ventricular dilatation and ventricular remodeling, which has shown an incomparable superiority over traditional therapies in the treatment of myocardial infarction complicated by heart failure. OBJECTIVE: To observe the clinical effects of single autologous peripheral blood stem celltransplantation in acute myocardial infarction patients with heart failure. METHODS:Since 2006 August to 2010 June, 23 patients who were diagnosed to have acute ST elevation myocardial infarction complicated with heart failure were selected and divided into two groups: celltransplantation group (n=11) and control group (n=12). Al patients underwent emergency coronary angiography and percutaneous coronary intervention with drug eluting stent implantation. In the stem celltransplantation group, peripheral blood stem cels positive for CD34 (about 1×108) were colected mobilized by granulocyte colony stimulating factor at 5 days after stent implantation, and then the cels were injected into infarcted vessels using coronary angiography method. Two-year folow-up was performed after celltransplantation to observe the cardiac function and adverse reactions in patients. RESULTS AND CONCLUSION:After 6 months of folow-up, the cardiac function in the celltransplantation group was improved significantly compared with that before celltransplantation (P < 0.05), and the left ventricular ejection fraction was increased by (6.2±0.2)% and the left ventricular end diastolic volume was reduced by (4.7±2.9) mm. However, there was no difference in folow-up results by the end of 1 and 2 years after celltransplantation (P > 0.05), as wel as no adverse reaction occurred. In the control group, after 6 months of folow-up, the left ventricular ejection fraction was reduced by (0.5±0.1)% and the left ventricular end diastolic volume was increased by (0.4±0.3) mm, which were deteriorated year after year. Percutaneous coronary intervention with autologous peripheral blood stem celltransplantation can significantly improve the left ventricular function, reduce left ventricular volume, and delay or prevent left ventricular remodeling in patients with acute myocardial infarction, which is safe and effective. But up to 2 years after celltransplantation, the cardiac function shows no further improvement.