自体骨髓干细胞移植改善心肌梗死后左心功能不全患者心脏功能

目的:评价经冠状动脉注射自体骨髓单个核细胞治疗心肌梗死后心功能不全的有效性. 方法:42例前壁心肌梗死患者BMSC(bone marrow stem cell,骨髓干细胞)组13例,对照组29例]接受标准介入和药物治疗,BMSC组同时接受自体骨髓单个核细胞冠状动脉内注射.两组于入选前及随访12个月时行纽约心脏病学会心功能分级(New York Heart Association Class, NYHA Class)、6分钟步行试验 (6 minute walk test, 6MWT)、单光子发射型计算机核素扫描(single photon emission computed tomography, SPECT)及血浆N末端B型钠尿肽原(NT-proBNP)检查. 结果:12个月时BMSC组患者NYHA心功能分级较前明显好转(1.54±0.27 vs. 2.62±0.33, P=0.002),且显著优于对照组(2.45±0.21,P=0.02);血浆NT-proBNP水平显著下降(701.05±154.60) ng/L vs. (1 921.70±373.70) ng/L,]P=0.000 8],但组间差异无统计学意义.12个月时两组的6MWT均显著增加BMSC组:(432.85±27.81) m vs.(363.77±20.14) m,P=0.000 6;对照组:(381.48±17.72) m vs.(339.00±9.87) m,P=0.000 5],]但组间差异无统计学意义.BMSC组术后12个月心肌血流灌注评分较前明显改善(31.15±3.65 vs. 46.31±]2.87,P=0.002),且显著优于对照组 (42.59±2.08,P=0.015 7);心肌核素缺损面积较前明显减少(32.23±]4.40)%] vs. (39.54±3.76)%,P=0.000 1],但组间差异无统计学意义;左心室射血分数(left ventricular ejection fraction, LVEF)提高(38.54±2.94)% vs.( 35.38±2.16)%,P>0.05].结论:经冠状动脉注射骨髓单个核细胞可改善心肌梗死后心功能不全患者的心肌血流灌注,提高心脏的收缩功能.

Intracoronary transfer autologous bone marrow stem cells can improve cardiac function in patients with left ventricular dysfunction after myocardial infarction

OBJECTIVE: To evaluate the efficacy of intracoronary transfer of autologous bone marrow mononuclear stem cells in patients with heart dysfunction after myocardial infarction. METHODS: Forty-two patients with anterior myocardial infarction BMSC(bone marrow mononuclear stem cells) group: 13 cases; control group: 29 cases] were treated by standard percutaneous coronary intervention (PCI) and medical therapy. Patients in BMSC group were also transplanted bone marrow mononuclear stem cells through coronary injection. Baseline and 12 months' follow-up evaluations included New York Heart Association Class ( NYHA class) and the level of plasma NT-proBNP, six minutes walk test, single photon emission computed tomography(SPECT). RESULTS: In BMSC group, the NYHA class improved significantly at the end of the 12 months' follow-up (1.54+/-0.27 vs. 2.62+/-0.33, P=0.002) and was better than that of control group (2.45+/-0.21, P=0.02). The level of plasma NTjproBNP reduced significantly (701.05+/-154.60) ng/L vs. (1,921.70+/-373.70) ng/L, P=0.000 8]. The distances of six minutes walk test of the two groups increased significantly BMSC group: (432.85+/-27.81) m vs. (363.77+/-20.14) m, P=0.000 6;control group: (381.48+/-17.72) m vs. (339.00+/-9.87) m, P=0.000 5], but the difference was not obvious between the two groups. The score of myocardial blood perfusion improved significantly in BMSC group at the end of the 12 months' follow-up (31.15+/-3.65 vs. 46.31+/-2.87, P=0.002) and was better than that of control group (42.59+/-2.08,P=0.015 7). The area of the perfusion defects in SPECT reduced significantly in BMSC group (32.23+/-4.40)% vs. (39.54+/-3.76)%, P=0.000 1], but no obvious difference was found between the two groups. Global LVEF of BMSC group increased (38.54+/-2.94)% vs. (35.38+/-2.16)%, P>0.05). CONCLUSION: Intracoronary transplantation of bone marrow mononuclear cells could improve myocardial blood perfusion and increase the systolic function in patients with heart failure after myocardial infarction.