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目的 评价经冠状动脉内自体骨髓单个核细胞移植对陈旧性心肌梗死患者心功能和心肌灌注的影响及其安全性。方法与结果 入选 10例陈旧性前壁心肌梗死患者 ,在冠状动脉造影和介入治疗后 ,经冠状动脉内灌注导管将自体骨髓单个核细胞缓慢注入前降支。随访 3个月后 ,左室射血分数由术前 4 5 3%± 9 8%升高至 5 4 5 %± 6 5 % (P =0 0 0 3) ;2 0 1 Tl心肌灌注显像 (SPECT)显示左心室心肌灌注明显改善 ,即刻和延迟心肌灌注评分分别由术前的 2 9 5± 5 8和 2 8 6± 6 3降低至 2 3 9±5 7和 2 3 0± 6 1(P均 <0 0 1) ,没有手术有关的并发症和恶性心律失常发生。结论 陈旧性前壁心肌梗死患者经冠状动脉内自体骨髓单个核细胞移植 ,可显著改善左室收缩功能和心肌灌注 ,并且具有良好的临床操作安全性。
Objective To evaluate the effect and safety of intracoronary autologous bone marrow mononuclear cell transplantation on cardiac function and myocardial perfusion in patients with old myocardial infarction. Methods and Results Ten patients with old anterior myocardial infarction were enrolled. After coronary angiography and interventional therapy, autologous bone marrow mononuclear cells were slowly injected into the anterior descending artery via intracoronary perfusion catheter. Left ventricular ejection fraction increased from 45.3% ± 9.8% preoperatively to 54.5% ± 6.5% (P = 0.003) after 3 months of follow-up. Myocardial perfusion imaging (SPECT) showed a significant improvement of left ventricular myocardial perfusion, immediate and delayed myocardial perfusion scores decreased from 295 ± 58 and 286 ± 6 3 preoperatively to 23.9 ± 57 and 230 ± 6 1, respectively (All P <0 01), there was no surgery-related complications and malignant arrhythmia. Conclusion Transplantation of autologous bone marrow mononuclear cells from coronary artery in patients with old anterior myocardial infarction can significantly improve left ventricular systolic function and myocardial perfusion and has good clinical safety.