经肝固有动脉自体骨髓间充质干细胞移植治疗失代偿期肝硬化的疗效及安全性

目的观察经肝固有动脉行自体骨髓间充质干细胞(BMSC)移植治疗失代偿期肝硬化的疗效及其安全性。方法将2012年6至2013年6月解放军第五三三医院肝病科收治的84例失代偿期患者随机分为移植组36例和对照组48例。对照组予以基础治疗(护肝、降黄、对症和支持治疗),移植组在基础治疗上行经肝固有动脉注入自体BMSC治疗。观察两组丙氨酸氨基转移酶(ALT)、白蛋白(Alb)、总胆红素(TBil)、凝血酶原时间(PT)、终末期肝病模型评分(MELD)的变化情况,分别在4、12、24、48周进行随访;两组肝功能指标比较用独立t检验,治疗后不同时间各肝功能指标的比较用F检验及LSD两两检验,两组之间肝癌发生率和病死率比较应用四格表χ2检验。结果治疗4周后,移植组腹水消退15例(41.7%),腹胀减轻21例(58.3%),下肢水肿减轻13例(36.1%),对照组分别为15例(31.3%)、20例(41.7%)和11例(22.9%),差异有统计学意义(χ2=8.341、12.689、9.837,P均0.05)。移植组治疗前及治疗后4、12、24、48周,ALT、Alb、TBil、PT和MELD评分,差异有统计学意义(F=6.172、9.795、10.961、11.198、19.652,P均=0.000);对照组治疗前及治疗后4、12、24、48周,ALT、Alb、TBil差异有统计学意义(F=5.594、13.664、12.612,P均=0.000),而PT和MELD评分,差异无统计学意义(F=1.698、2.652,P均0.05)。移植组与对照组相比,治疗后第4周ALT、Alb、TBil、PT差异有统计学意义(t=3.394、11.625、8.847、15.781,P均0.05),MELD差异无统计学意义(t=1.727,P0.05);治疗后第48周,ALT、Alb、TBil、PT、MELD差异有统计学意义(t=5.477、8.830、6.371、11.362、9.426,P均0.05)。随访至第48周,移植组与对照组病死率及肝癌发生率均差异无统计学意义(χ2=4.815、6.286,P均0.05)。全部患者在移植术中,移植术后近期未发生严重并发症。结论经肝固有动脉自体BMSC移植治疗失代偿期肝硬化是一种安全、有效的方法,可作为肝移植治疗的过渡或补充治疗。

Clinical study of autologous bone marrow mesenchymal stem cells transplantation through proper hepatic artery for decompensated cirrhosis patients

Objective To investigate the clinical therapeutic effect and safety of autologous bone marrow mesenchymal stem cells (BMSC)transplantation through proper hepatic artery in patients with decompensated liver cirrhosis.Methods 4,12,24,48,there were significant improvements in ALT,Alb,TBiL,PT and MELD (F =6.172,9.795,10.961 , 11 .198,19.652,P =0.000,respectively)than those at baseline.In control group,some parameters,including ALT,Alb and TBiL,had significant improvement (F =5.594,13.664,12.612,P =0.000,respectively),while other parameters, including PT and MELD,did not changed before and after therapy.At week 48,ALT,Alb,TBiL,PT and MELD showed significant differences between transplantation and control groups (t =5.477,8.830,6.371 ,11 .362,9.426,P <0.05, respectively).No significant differences were observed in incidence of HCC and mortality (χ2 =4.815、6.286,P <0.05, respectively).Additionally,no severe adverse effects occured in patients during and after transplantation.Conclusion Autologous BMSC transplantation through proper hepatic artery for decompensated liver cirrhosis is a safe and effective therapy,which could be a bridging or a complementary treatment.