疑难病杂志
疑難病雜誌
의난병잡지
JOURNAL OF DIFFICULT AND COMPLICATED CASES
2014年
11期
1126-1129,1133
,共5页
王可敬%罗晓红%孙厚坦%王方%包建涛
王可敬%囉曉紅%孫厚坦%王方%包建濤
왕가경%라효홍%손후탄%왕방%포건도
脐血干细胞%肝硬化%失代偿期%血流动力学
臍血榦細胞%肝硬化%失代償期%血流動力學
제혈간세포%간경화%실대상기%혈류동역학
Umbilical cord blood stem cells%Liver cirrhosis%Decompensation%Hemodynamics
目的:观察脐血干细胞移植治疗失代偿期肝硬化的疗效及对肝血流动力学的影响。方法选择失代偿期肝硬化患者30例为治疗组,经肝固有动脉进行异体人脐血干细胞移植;选择资料匹配的同期住院未行脐血干细胞输注的失代偿期肝硬化患者20例作为对照组。比较2组患者肝功能、凝血功能、门静脉血流动力学、B型超声肝脏体积及造影剂消退时间等指标,并观察患者临床症状改善情况及不良反应。结果治疗组肝内脐血干细胞移植成功率为100%,无不良反应和并发症发生。与治疗前比较,2组治疗后3、6个月谷氨酸氨基转移酶( ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(Alb)均有改善( P <0?.05),且治疗组Alb改善优于对照组( P <0.05);与治疗前比较,治疗组治疗3、6个月总胆红素(TBil)明显降低,对照组治疗6个月时降低( P <0.05);治疗组治疗1、3、6个月后甲胎蛋白(AFP)明显增加,且与对照组同时点比较差异有统计学意义( P <0.05)。与移植前比较,治疗组凝血酶原时间(PT)于移植后3、6个月显著下降( P <0.05),与对照组比较差异显著( P <0.05);纤维蛋白原(Fib)在移植后3、6个月显著增加( P <0.05),与对照组比较差异不显著( P >0.05)。凝血活酶时间(APTT)和凝血时间(TT)在移植后均呈降低趋势,但与移植前差异不显著,对照组亦无明显变化( P >0.05)。与治疗前比较,2组门静脉内径(DPV)、脾静脉内径(DSV)、门静脉最大流速(PVX)、脾静脉最大流速(SVV)、门静脉血流量(QPV)、脾静脉血流量(QSV)差异均无统计学意义( P >0.05)。治疗后,2组肝脏体积均有增大趋势,但比较差异均无统计学意义( P >0.05) 。与治疗前比较,脐血干细胞移植后,治疗组造影剂消退时间明显减慢( P <0.05),与对照组比较差异有统计学意义( P <0.05)。结论经肝固有动脉行脐血干细胞移植治疗失代偿期肝硬化可以改善肝功能及静脉血流情况,且安全有效,为临床肝病的治疗探索了新途径。
目的:觀察臍血榦細胞移植治療失代償期肝硬化的療效及對肝血流動力學的影響。方法選擇失代償期肝硬化患者30例為治療組,經肝固有動脈進行異體人臍血榦細胞移植;選擇資料匹配的同期住院未行臍血榦細胞輸註的失代償期肝硬化患者20例作為對照組。比較2組患者肝功能、凝血功能、門靜脈血流動力學、B型超聲肝髒體積及造影劑消退時間等指標,併觀察患者臨床癥狀改善情況及不良反應。結果治療組肝內臍血榦細胞移植成功率為100%,無不良反應和併髮癥髮生。與治療前比較,2組治療後3、6箇月穀氨痠氨基轉移酶( ALT)、天鼕氨痠氨基轉移酶(AST)、白蛋白(Alb)均有改善( P <0?.05),且治療組Alb改善優于對照組( P <0.05);與治療前比較,治療組治療3、6箇月總膽紅素(TBil)明顯降低,對照組治療6箇月時降低( P <0.05);治療組治療1、3、6箇月後甲胎蛋白(AFP)明顯增加,且與對照組同時點比較差異有統計學意義( P <0.05)。與移植前比較,治療組凝血酶原時間(PT)于移植後3、6箇月顯著下降( P <0.05),與對照組比較差異顯著( P <0.05);纖維蛋白原(Fib)在移植後3、6箇月顯著增加( P <0.05),與對照組比較差異不顯著( P >0.05)。凝血活酶時間(APTT)和凝血時間(TT)在移植後均呈降低趨勢,但與移植前差異不顯著,對照組亦無明顯變化( P >0.05)。與治療前比較,2組門靜脈內徑(DPV)、脾靜脈內徑(DSV)、門靜脈最大流速(PVX)、脾靜脈最大流速(SVV)、門靜脈血流量(QPV)、脾靜脈血流量(QSV)差異均無統計學意義( P >0.05)。治療後,2組肝髒體積均有增大趨勢,但比較差異均無統計學意義( P >0.05) 。與治療前比較,臍血榦細胞移植後,治療組造影劑消退時間明顯減慢( P <0.05),與對照組比較差異有統計學意義( P <0.05)。結論經肝固有動脈行臍血榦細胞移植治療失代償期肝硬化可以改善肝功能及靜脈血流情況,且安全有效,為臨床肝病的治療探索瞭新途徑。
목적:관찰제혈간세포이식치료실대상기간경화적료효급대간혈류동역학적영향。방법선택실대상기간경화환자30례위치료조,경간고유동맥진행이체인제혈간세포이식;선택자료필배적동기주원미행제혈간세포수주적실대상기간경화환자20례작위대조조。비교2조환자간공능、응혈공능、문정맥혈류동역학、B형초성간장체적급조영제소퇴시간등지표,병관찰환자림상증상개선정황급불량반응。결과치료조간내제혈간세포이식성공솔위100%,무불량반응화병발증발생。여치료전비교,2조치료후3、6개월곡안산안기전이매( ALT)、천동안산안기전이매(AST)、백단백(Alb)균유개선( P <0?.05),차치료조Alb개선우우대조조( P <0.05);여치료전비교,치료조치료3、6개월총담홍소(TBil)명현강저,대조조치료6개월시강저( P <0.05);치료조치료1、3、6개월후갑태단백(AFP)명현증가,차여대조조동시점비교차이유통계학의의( P <0.05)。여이식전비교,치료조응혈매원시간(PT)우이식후3、6개월현저하강( P <0.05),여대조조비교차이현저( P <0.05);섬유단백원(Fib)재이식후3、6개월현저증가( P <0.05),여대조조비교차이불현저( P >0.05)。응혈활매시간(APTT)화응혈시간(TT)재이식후균정강저추세,단여이식전차이불현저,대조조역무명현변화( P >0.05)。여치료전비교,2조문정맥내경(DPV)、비정맥내경(DSV)、문정맥최대류속(PVX)、비정맥최대류속(SVV)、문정맥혈류량(QPV)、비정맥혈류량(QSV)차이균무통계학의의( P >0.05)。치료후,2조간장체적균유증대추세,단비교차이균무통계학의의( P >0.05) 。여치료전비교,제혈간세포이식후,치료조조영제소퇴시간명현감만( P <0.05),여대조조비교차이유통계학의의( P <0.05)。결론경간고유동맥행제혈간세포이식치료실대상기간경화가이개선간공능급정맥혈류정황,차안전유효,위림상간병적치료탐색료신도경。
Objective To observe the therapeutic effect of umbilical cord blood stem cells transplantation in the treat -ment of decompensated cirrhosis of the liver and the effects on liver hemodynamics .Methods 30 cases of patients with de-compensated liver cirrhosis as treatment group , underwent the proper hepatic artery allogeneic umbilical cord blood stem cell transplantation;chosen the data matched 20 cases of patients with decompensated cirrhosis who did not receive the injection of umbilical cord blood stem cells treatment as the control group .Liver function , coagulation function , hemodynamics of portal vein, B ultrasound contrast agent was compared between the 2 groups of patients .The time of the liver volume and other indi-cators, the clinical symptoms and adverse reaction were observed .Results The success rate of intrahepatic umbilical cord blood stem cell transplantation was 100%in the treatment group , no adverse reaction and complication were occurred. Com-pared with before treatment, after the treatment in the 2 groups, 3, 6 months of glutamate aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb) were improved ( P <0.05), and the Alb in the treatment group was better than the control group ( P <0.05 ); and compared with before treatment , in the treatment group , 3, 6 months of total bilirubin (TBil) decreased significantly, control group reduces at 6 months after treatment ( P <0.05);in treatment group, 1, 3, 6 months later , AFP significantly increased , compared with the control group at the same time , the difference was statistically significant( P <0.05).Compared with the treatment group before transplantation ,prothrombin time(PT)after transplantation in 3, 6 months was significantly decreased ( P <0 ?.05), the difference was significant compared with control group ( P <0.05);fibrinogen (Fib) in 3, 6 months after transplantation was significantly increased ( P <0.05), compared with the control group, the difference was not significant ( P >0.05).Thromboplastin time (APTT) and prothrombin time (TT) after transplantation showed a decreasing trend , but with no significant difference before transplantation , the control group had no significant changes ( P >0.05).Compared with before treatment, 2 groups of portal vein diameter (DPV), splenic vein (DSV), portal vein flow velocity (PVX), splenic vein (SVV), portal venous blood flow (QPV), splenic vein blood flow (QSV) did not show statistically significant differences ( P >0.05).After treatment, 2 groups of liver volume were showing increasing trend, but no significant difference were found ( P >0.05).Compared with before treatment, umbilical cord blood stem cell transplantation, the treatment group contrast agent subsided significantly slow down ( P <0.05), compared with the control group, a statistically significant difference were found ( P <0.05).Conclusion The proper hepatic artery umbilical cord blood stem cell transplantation in the treatment of decompensated cirrhosis can improve liver function and blood flow , is a new approach for the treatment of liver diseases .