论文部分内容阅读
目的探讨急性心肌梗死患者经冠状动脉自体骨髓单个核细胞治疗的安全性和对心功能的保护作用。方法2003年3月以来,84例急性心肌梗死患者急诊静脉溶栓或急诊PCI治疗后2周内行择期冠状动脉造影或PCI治疗。其中50例作为细胞治疗组,抽取骨髓40mL,提取单个核细胞,经冠状动脉注入;另34例作为对照组,经冠状动脉注入等量生理盐水。81例患者术前和术后6个月、2年行多巴酚丁胺负荷试验。29例治疗组患者和22例对照组患者术前和术后6个月行静态及动态心肌核素显像检查。结果细胞治疗组患者临床随访无明显副作用,心功能明显改善,运动耐力增加。多巴酚丁胺超声心动图负荷试验示左室射血分数(术前27.00%±0.89%,术后6个月36.80%±0.58%,术后2年40.94%±0.58%,术后6个月、2年与术前比,P均<0.01)和室壁运动记分指数(术前1.55±0.05,术后6个月1.32±0.03,术后2年1.24±0.02,术后6个月、2年与术前比,P均<0.01)显著改善,峰值射血分数(EF)与基础状态EF的差值(术前0.88%±0.54%,术后6个月15.06%±0.43%,术后6个月与术前比,P<0.01)及WMSI和基础状态WMSI的差值(术前0.07±0.02,术后6个月0.19±0.02,术后2年0.15±0.01,术后6个月、2年与术前比,P均<0.01)治疗前后之差异有统计学意义。动态与静态心肌核素显像提示梗死和缺血面积减小,存活心肌增加。结论经冠状动脉自体骨髓单个核细胞治疗的急性心肌梗死患者,经2年的临床观察无明显副作用,具备安全性,并显示出自体骨髓单个核细胞治疗对梗死后心功能有保护作用。
Objective To investigate the safety and cardiac function of coronary artery autologous bone marrow mononuclear cells in patients with acute myocardial infarction. Methods From March 2003, 84 patients with acute myocardial infarction underwent elective coronary angiography or PCI within 2 weeks after emergency intravenous thrombolysis or emergency PCI. Among them, 50 cases were used as cell therapy group, bone marrow was extracted from 40mL, mononuclear cells were extracted and injected into coronary artery; the other 34 cases were used as control group, and the same amount of normal saline was injected through coronary artery. Eighty-one patients underwent dobutamine stress test two months before surgery and 6 months after surgery. Twenty-nine patients in the treatment group and 22 patients in the control group underwent static and dynamic myocardial imaging before and 6 months after operation. Results The patients in the cell therapy group had no obvious side-effects in clinical follow-up, heart function improved significantly, and exercise tolerance increased. Dobutamine stress echocardiography load test showed left ventricular ejection fraction (27.00% ± 0.89% before surgery, 6 months after surgery, 36.80% ± 0.58%, 2 years after 40.94% ± 0.58%, 6 Month, 2 years and preoperation, P <0.01) and wall motion score index (1.55 ± 0.05 before surgery, 1.32 ± 0.03 6 months after surgery, 1.24 ± 0.02 2 months after surgery, 6 months after surgery, 2 (P <0.01), and the difference between the peak ejection fraction (EF) and the basal state EF (0.88% ± 0.54% preoperatively and 15.06% ± 0.43% postoperatively 6 months postoperatively 6 months and preoperative, P <0.01) and WMSI and baseline WMSI (preoperative 0.07 ± 0.02, 6 months after operation 0.19 ± 0.02, 2 years after surgery 0.15 ± 0.01, 6 months after surgery , 2 years and preoperative, P <0.01) before and after treatment, the difference was statistically significant. Dynamic and static myocardial nuclear imaging prompted infarction and ischemic area is reduced, increased myocardial viability. Conclusions Patients with acute myocardial infarction treated with autologous bone marrow mononuclear cells of coronary artery have no obvious side effects after 2 years of clinical observation and are safe. They also show that autologous bone marrow mononuclear cells have a protective effect on cardiac function after infarction.