CAJ | 학술논문

目的探讨自体骨髓间充质干细胞(MSCs)移植对肝硬化失代偿期患者的治疗作用.方法 25例肝硬化失代偿期及肝衰竭患者无菌抽取骨髓150 ～ 200 ml,参照Wollert报道方法分离纯化MSCs,然后经肝动脉导管注入肝脏.术后定期检测肝功能和凝血功能,并观察同期的症状体征和不良反应情况.结果术后2周内所有血清学指标均无显著性改变；与术前[(26.65±5.30) g/L]比较术后4周血清白蛋白为(30.91±4.00) g/L(t =3.07,P＜O.05).至12周升至(32.00±6.18) g/L(t =3.02,P＜0.01)；术后12周与术前比较总胆红素[(39.94±21.15)mmol/L与(125.01±150.05) mmol/L,t =2.63,P＜0.05]；总胆汁酸[(41.63±33.91) μnol/L与(78.00±59.80) μmol/L,t =2.53,P＜O.05],差异均有统计学意义.肝酶指标术后4周与术前比较均有明显变化(P均＜0.05).术后12周与术前比较凝血酶时间及纤维蛋白原分别为(14.71±1.59)s与(21.40±6.07)s(t =5.01,P＜0.01)和(2.64±0.61) g/L(1.66±0.94) g/L(t =4.17,P＜0.01).术后1周食欲、体力改善分别为90.67％和88.5％；第2周16例患者(63.5％)肝病面容好转,有1例蜘蛛痣明显减少；术后12周的总生存率为77.44％,其中移植2周后死亡及失访者共3例,死因为慢性肝衰竭合并自发性细菌性腹膜炎或DIC或肝肾综合征.所有患者均未发现细胞移植并发症.结论自体MSCs移植治疗失代偿期肝硬化近期安全有效,患者肝功能、凝血功能改善明显,生存质量提高,但应严格掌握适应证.
목적 탐토자체골수간충질간세포(MSCs)이식대간경화실대상기환자적치료작용.방법 25례간경화실대상기급간쇠갈환자무균추취골수150 ～ 200 ml,삼조Wollert보도방법분리순화MSCs,연후경간동맥도관주입간장.술후정기검측간공능화응혈공능,병관찰동기적증상체정화불량반응정황.결과 술후2주내소유혈청학지표균무현저성개변；여술전[(26.65±5.30) g/L]비교술후4주혈청백단백위(30.91±4.00) g/L(t =3.07,P＜O.05).지12주승지(32.00±6.18) g/L(t =3.02,P＜0.01)；술후12주여술전비교총담홍소[(39.94±21.15)mmol/L여(125.01±150.05) mmol/L,t =2.63,P＜0.05]；총담즙산[(41.63±33.91) μnol/L여(78.00±59.80) μmol/L,t =2.53,P＜O.05],차이균유통계학의의.간매지표술후4주여술전비교균유명현변화(P균＜0.05).술후12주여술전비교응혈매시간급섬유단백원분별위(14.71±1.59)s여(21.40±6.07)s(t =5.01,P＜0.01)화(2.64±0.61) g/L(1.66±0.94) g/L(t =4.17,P＜0.01).술후1주식욕、체력개선분별위90.67％화88.5％；제2주16례환자(63.5％)간병면용호전,유1례지주지명현감소；술후12주적총생존솔위77.44％,기중이식2주후사망급실방자공3례,사인위만성간쇠갈합병자발성세균성복막염혹DIC혹간신종합정.소유환자균미발현세포이식병발증.결론 자체MSCs이식치료실대상기간경화근기안전유효,환자간공능、응혈공능개선명현,생존질량제고,단응엄격장악괄응증.
Objective To evaluate the effect of autologous bone marrow-derived stem cell (MSCs)transplantation in the treatment of decompensated hepatic cirrhosis.Methods Bone marrow was harvested (150-200 ml) from 25 patients with decompensated cirrhosis and hepatic failure.The MSCs were isolated according to the method reported by Wollert and infused into liver via hepatic artery catheter.At different time points after the transplantation,the patients' liver function and prothrombin time(PT) were evaluated,and the survival rate and symptoms of the patients were recorded.Results All the serum biochemical indexes remained stable 2 weeks after the transplantation,and at 4 weeks after transplantation,levels of albumin was increased significantly in comparison with the preoperative level((30.91 ±4.00) g/L vs (26.65 ±5.30) g/L,t =3.07,P ＜0.05).At 12 weeks,the levels of albumin further increased((32.00 ±6.18) g/L vs (26.65 ±5.30) g/L,t =3.02 P ＜ 0.01).While at 12 weeks after operation,there was significant difference on the total bilirubin ((39.94 ± 21.15) mmol/L vs (125.01 ± 150.05) mmol/L; t =2.63,P ＜ 0.05),tolal bile acid ((41.63 ±33.91) μmol/L vs (78.00 ± 59.80) pmol/L;t =2.53,P ＜ 0.05) when compared with the preoperative level.4weeks after operation,the liver enzyme indicators changed significantly when compared with the preoperative level (P ＜0.05).At 12 weeks after operation,there was significant difference on the PT((14.71 ± 1.59) s vs (21.40 ± 6.07) s,t =5.01,P ＜ 0.01) and the level of fibrinogen ((2.64 ± 0.61) g/L vs (1.66 ± 0.94) g/L,t =4.17,P ＜0.01).1 week after the transplantation,90.67％ patients exhibited improved appetite and 88.5％patients showed better physical strength; at 2 weeks,hepatic face improved in 16 cases (63.5％),and spider telangiectasia was significantly reduced in 1 case;at 12 weeks,the survival rate of the patients was 77.44％,and 3 died or gave up treatment due to chronic liver failure complicated by spontaneous bacterial peritonitis,hepatorenal syndrome,or DIC.No complications associated with the transplantation occurred in these patients.Conclusion MSCs transplantation can significantly improve the liver function of patients with decompensated hepatic cirrhosis with good safety and effectiveness,but the indications should be strictly controlled.