CAJ | 학술논문

背景：骨髓干细胞应用于治疗失代偿期肝硬化有较多单中心研究报道，效果均不理想，其原因可能与肝硬化患者年龄大、体质弱，骨髓造血功能差，能够获取的干细胞数量少，再生和增殖能力弱有关，而脐带间充质干细胞具有易获得、来源广、免疫原性弱等特点。二者联合移植有可能提高其对失代偿期肝硬化患者的治疗效果。目的：探讨脐带间充质干细胞联合骨髓干细胞治疗失代偿期肝硬化的疗效及安全性。方法：失代偿期肝硬化患者32例随机分为两组，对照组19例单纯内科综合治疗，干细胞组13例在内科治疗基础上进行脐带间充质干细胞联合骨髓干细胞移植。跟踪观察随访1年，分别于治疗后4，12，52周观察并详细记录患者肝功能(丙氨酸转氨酶、总胆红素、白蛋白)、凝血酶原时间、Child-Pugh评分、MELD评分、患者1年生存率、临床生活质量评分(QOL)及干细胞治疗相关不良反应。结果与结论：在治疗后4，12，52周，干细胞组和对照组肝功能、凝血酶原时间、Child-Pugh评分、MELD评分等指标较治疗前均有改善，但两组对比差异无显著性意义(P >0.05)；移植后4周患者临床症状及临床生活质量评分(QOL)有较快改善，与对照组相比差异有显著性意义(P<0.05)，在治疗后12，52周时差异无显著性意义(P >0.05)；两组患者1年生存率无明显差异，未发生与细胞治疗相关的严重并发症。结果表明脐带间充质干细胞联合骨髓干细胞移植能够较快地改善失代偿期肝硬化患者临床症状，安全性好，但对其确切疗效有待扩大样本量进一步深入研究。
배경：골수간세포응용우치료실대상기간경화유교다단중심연구보도，효과균불이상，기원인가능여간경화환자년령대、체질약，골수조혈공능차，능구획취적간세포수량소，재생화증식능력약유관，이제대간충질간세포구유역획득、래원엄、면역원성약등특점。이자연합이식유가능제고기대실대상기간경화환자적치료효과。목적：탐토제대간충질간세포연합골수간세포치료실대상기간경화적료효급안전성。방법：실대상기간경화환자32례수궤분위량조，대조조19례단순내과종합치료，간세포조13례재내과치료기출상진행제대간충질간세포연합골수간세포이식。근종관찰수방1년，분별우치료후4，12，52주관찰병상세기록환자간공능(병안산전안매、총담홍소、백단백)、응혈매원시간、Child-Pugh평분、MELD평분、환자1년생존솔、림상생활질량평분(QOL)급간세포치료상관불량반응。결과여결론：재치료후4，12，52주，간세포조화대조조간공능、응혈매원시간、Child-Pugh평분、MELD평분등지표교치료전균유개선，단량조대비차이무현저성의의(P >0.05)；이식후4주환자림상증상급림상생활질량평분(QOL)유교쾌개선，여대조조상비차이유현저성의의(P<0.05)，재치료후12，52주시차이무현저성의의(P >0.05)；량조환자1년생존솔무명현차이，미발생여세포치료상관적엄중병발증。결과표명제대간충질간세포연합골수간세포이식능구교쾌지개선실대상기간경화환자림상증상，안전성호，단대기학절료효유대확대양본량진일보심입연구。
BACKGROUND:There are most single-center studies about bone marrow stem cels applied to treat decompensated cirrhosis, but the therapeutic results are not ideal. It is possibly related to aging, physical weakness, poor bone marrow hematopoietic function, less available number of stem cels and feeble ability of regeneration and proliferation in liver cirrhosis patients. Umbilical cord mesenchymal stem cels are characterized of easy to obtain, wide source and weak immunogenicity. Co-transplantation of bone marrow stem cels and umbilical cord mesenchymal stem cels may improve the therapeutic effects on decompensated cirrhosis patients. OBJECTIVE:To investigate the efficacy and safety of co-transplantation of umbilical cord mesenchymal stem cels and bone marrow stem cels on decompensated cirrhosis.METHODS:Thirty-two decompensated cirrhosis patients were randomly divided into two groups: in stem cel group, 13 patients received co-transplantation of umbilical cord mesenchymal stem cels and bone marrow stem cels based on regular medical treatment; in control group, 19 patients only underwent the regular medical treatment. Al the patients were folow-up for 1 year. Alanine aminotransferase, albumin, total bilirubin, prothrombin time, Child-Pugh score and Model for End-Stage Liver Disease score, 1-year survival rate, Quality of Life score and adverse reactions related to stem cel therapy were observed and recorded in the two groups at 4, 12, 52 weeks after treatment. RESULTS AND CONCLUSION:At 4, 12, 52 weeks after treatment, improvements in the liver function, prothrombin time, Child-Pugh score and Model for End-Stage Liver Disease score were found in the two groups, but there was no difference between the two groups (P > 0.05). At 4 weeks after transplantation, the clinical symptoms and Quality of Life score in the stem cel group were significantly improved, which were better than those in the control group (P < 0.05). But at 12 and 52 weeks after treatment, no difference was found between the two groups (P > 0.05). In addition, the 1-year survival rate showed no difference between the two groups, and no severe adverse reactions related to stem cel therapy occurred during the folow-up. Co-transplantation of umbilical cord mesenchymal stem cels and bone marrow stem cels is safe and effective to improve the clinical symptoms of decompensated cirrhosis patients. However, further studies with larger samples are warranted to better clarify the co-transplantation effects.