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目的评价急诊经冠状动脉内骨髓细胞移植治疗急性心肌梗死是否可行。方法20例发病在24h内的急性心肌梗死患者随机分成骨髓移植组(n=10)和对照组(n=10),分别在急诊经皮冠状动脉介入治疗(PCI)成功后3h内经导管注入自体骨髓单个核细胞或安慰剂至梗死相关冠状动脉。随访患者PCI术后1周及6个月左室射血分数(LVEF)、左心室舒张末期内径(LVDd)以及心肌灌注缺损指数。结果经胸心脏超声提示移植组LVEF由术后1周53.8%±9.2%升至58.6%±9.9%(P<0.05),而对照组无显著变化(58.2%±7.5%比56.3%±3.5%,P>0.05);随访移植组LVDd维持不变(52.5±2.8mm比52.1±3.2mm,P>0.05),而对照组LVDd由术后1周50.4±6.0mm增加至55.2±7.1mm(P<0.05)。单光子放射计算机断层显像术(SPECT)提示移植组心肌灌注缺损指数由21±11降低至13±10(P<0.01),而对照组变化不显著。结论急诊经冠状动脉自体骨髓单个核细胞移植可以显著改善急性心肌梗死患者远期左心室收缩功能和心肌血流灌注,并有效防止远期左心室扩大。
Objective To evaluate the feasibility of emergency treatment of acute myocardial infarction by intracoronary transplantation of bone marrow cells. Methods Twenty patients with acute myocardial infarction within 24 h were randomly divided into three groups: the bone marrow transplantation group (n = 10) and the control group (n = 10). The patients were injected with autologous intraepithelial neoplasm within 3 hours after emergency percutaneous coronary intervention (PCI) Bone marrow mononuclear cells or placebo to infarct-related coronary arteries. The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd) and myocardial perfusion defect index at 1 week and 6 months after PCI were observed. Results The transcranial ultrasound showed that the LVEF in the graft group increased from 53.8% ± 9.2% to 58.6% ± 9.9% (P <0.05) at 1 week after operation, while no significant change was found in the control group (58.2% ± 7.5% vs. 56.3% ± 3.5% , P> 0.05). The LVDd in the follow-up group remained unchanged (52.5 ± 2.8mm vs 52.1 ± 3.2mm, P> 0.05), while the LVDd in the control group increased from 50.4 ± 6.0mm to 55.2 ± 7.1mm <0.05). Single photon emission computed tomography (SPECT) suggested that the myocardial perfusion defect index in the transplantation group decreased from 21 ± 11 to 13 ± 10 (P <0.01), but not in the control group. Conclusion Emergency transcoronary autologous bone marrow mononuclear cells transplantation can significantly improve long-term left ventricular systolic function and myocardial perfusion in patients with acute myocardial infarction and effectively prevent long-term left ventricular enlargement.