自体骨髓间充质干细胞移植修复无功能心肌的对比

背景：目前有关干细胞技术的临床试验多集中在心肌梗死方面,对原发性心肌病研究尚少,且尚未见到两者对比的相关报道。 目的：比较自体骨髓间充质干细胞经冠状动脉内移植修复缺血及非缺血所致无功能心肌的有效性及安全性。 方法：38例拟行择期经皮冠状动脉介入治疗的急性心肌梗死患者随机分为对照A组与试验A组,36例扩张型心肌病患者随机分为对照B组与试验B组。对照组与试验组在介入治疗后分别通过大腔导管于相应冠状动脉内注入等量生理盐水与骨髓间充质干细胞。 结果与结论：移植后1个月试验组左室射血分数较移植前和对照组显著升高(P < 0.05);移植后3个月试验组左室射血分数较移植前和对照组明显升高、心肌灌注缺损面积百分比较移植前和对照组明显降低(P < 0.05),而试验组间仅左室射血分数差异有显著性意义(P < 0.05);试验A组左室舒张末期内径较移植前、对照A组和试验B组均明显减小(P < 0.05),而试验B组仅较移植前明显降低(P < 0.05)。随访期间恶性心血管事件发生率在试验组和对照组间无显著性差异(P > 0.05)。提示经冠状动脉途径行骨髓间充质干细胞移植对无功能心肌的修复是安全有效的,且对急性心肌梗死的疗效优于扩张型心肌病。

Autologous bone marrow mesenchymal stem cells for myocardial renewal and repair

BACKGROUND:Current clinical trials of stem cell transplantation focus on the research field of myocardial infarction. Few studies are about primary cardiomyopathy, and there have been no reports describing the comparison between myocardial infarction and primary cardiomyopathy. OBJECTIVE:To assess the efficacy and safety of intracoronary transplantation of autologous bone marrow mesenchymal stem cells for treatment of non-functional myocardium caused by ischemic or non-ischemic diseases. METHODS:38 patients who underwent selective percutaneous coronary intervention due to myocardial infaction were divided into trial A group and control A group randomly. 36 patients with dilated cardiomyopathy were divided into trial B group and control B group randomly. Equal amounts of normal saline or bone marrow mesenchymal stem cells were infused into corresponding coronary artery through the guiding catheter post-operation in control groups and trial groups respectively. RESULTS AND CONCLUSION:At 1 month after transplantation, compared with prior to transplantation and control groups, only left ventricular ejection fraction in the trial groups increased significantly (P < 0.05). At 3 months after transplantation, compared with prior to transplantation and control groups, the left ventricular ejection fraction in the trial groups increased significantly while myocardial perfusion defects in the trial groups were significantly reduced (P < 0.05); however, at this time point, there was significant difference in the left ventricular ejection fraction between trial groups (P < 0.05); the left ventricular end-diastolic diameter in the trial A group decreased significantly compared with prior to transplantation, control A group and trial B group (P < 0.05), while the trail B group showed significantly decreased left ventricular end-diastolic diameter only compared with prior to transplantation (P < 0.05). There was no significant difference in incidence of malignant cardiovascular events between trail groups and control groups during follow-up period (P > 0.05). Intracoronary transplantation of bone marrow mesenchymal stem cells is safe and effective in renewal and repair of non-functional myocardium and its efficacy in acute myocardial infarction patients is better than dilated cardiomyopathy patients.