自体骨髓间充质干细胞移植治疗扩张型心肌病的临床观察

目的观察自体骨髓间充质干细胞经冠状动脉移植治疗扩张型心肌病的临床疗效。方法 38例NYHA心功能Ⅱ～Ⅳ级、心肌存在灌注缺损且左心室射血分数<40%的扩张型心肌病患者随机分为观察组18例和对照组20例,均通过冠脉动脉造影于冠状动脉内分别注入等量骨髓间充质干细胞和生理盐水。随访3个月并记录不同时期左心室射血分数、左心室舒张末期内径和心肌灌注缺损面积等指标,并通过24hHolter方法记录恶性心血管事件的发生。结果观察组术后1,3个月左心室射血分数均较术前及同期对照组明显增加(P<0.05),对照组术后3个月较术前明显增加(P<0.05);术后1个月观察组左心室舒张末期内径较术前减小(P<0.05),对照组较术前增加(P<0.05),2组差异有统计学意义(P<0.05);术后3个月时观察组左心室舒张末期内径较术前及术后1个月时均明显减少(P<0.05),对照组较术前增加(P<0.05),与1个月时比较差异无统计学意义(P>0.05),2组差异无统计学意义(P>0.05);术后3个月观察组灌注缺损面积百分比较术前及术后1个月时降低(P<0.05),对照组较术前降低(P<0.05);2组恶性临床事件差异无统计学意义(P>0.05)。结论自体骨髓间充质干细胞移植治疗扩张型心肌病安全、有效。

Autologous bone marrow mesenchymal stem cells transplantation for dilated cardiomyopathy

Objective To observe the clinical effect of coronary transplantation of bone marrow mesenchymal stem cells(BMSCs) on dilated cardiomyopathy(DCM).Methods Thirty-eight DCM patients with NYHA Ⅱ～Ⅳ class,myocardial perfusion defects and left ventricular ejection fraction(LVEF) under 40% were randomly divided into observation group receiving infusion of BMSCs via coronary artery during coronary angiography(n=18) and control group receiving the same amount of normal saline(n=20).The change of left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd) and perfusion defects of myocardium were assessed in 3 months after the procedure in all patients,and the malignant cardiovascular events were recorded with 24-hour Holter electrocardiograph.Results LVEF was obviously higher in one and three months in the observation group than that before treatment,and also higher in the observation group than that in control group(P<0.05),and it was higher in three months than that before treatment in control group(P>0.05).LVEDd was lower in the observation group(P<0.05),and higher in control group one month after treatment than that before treatment(P<0.05),which showed a significant difference between two groups(P<0.05).LVEDd was obviously lower three months after treatment than that before treatment and one month after treatment in the observation group(P<0.05),LVEDd was higher three months after treatment than that before treatment in control group(P<0.05),and there was no significant difference compared with one month after treatment(P>0.05).There was no significant difference in LVEDd three months after treatment between two groups(P>0.05).Perfusion defect percentage was lower three months after treatment than that before operation and one month after treatment in the observation group(P<0.05),and was lower than that before treatment in control group(P<0.05).There was no difference in malignant arrhythmia events between two groups during follow-up(P>0.05).No death was recorded during the follow-up period.Conclusion BMSCs transplantation is safe and effective in treating DCM.