【摘要】 目的探讨外周血干细胞冠脉内移植治疗心梗后合并心功能不全病例疗效、安全性及对左室功能的影响.方法选择2005年6月至2007年3月心梗后合并心功能不全冠心病53例,均行PCI治疗,根据是否行干细胞移植治疗分为干细胞移植组23例及对照组30例,干细胞移植组在常规冠心病治疗(药物与介入治疗)的基础上应用粒细胞集落刺激因子皮下注射动员自身骨髓干细胞,连用5d,第6天分离外周血干细胞悬液,将采集后的干细胞悬液经over the wire球囊导管注入梗死相关动脉(IRA),进行外周血干细胞移植,对照组经冠心病常规方法(药物与介入)治疗,在外周血干细胞动员、采集及经冠脉回输过程中,观察其安全性及不良反应,两组在移植前及移植后6个月内运用超声心动图评价左室形态及心功能指标、室壁节段运动指数,比较两组生存率及心脏事件发生率.结果6个月时干细胞移植组冠脉内移植术前、术后比较心脏收缩末容积(ESV)明显减小,舒张末容积(EDV)明显减小,左室射血分数显著增高,左室壁节段运动指数明显减低,比较均有统计学差异,对照组上述指标PCI术前、术后比较均有改善,但无统计学差异,干细胞移植组与对照组术后上述指标比较有统计学差异,两组术后6月生存率及心脏事件发生率无统计学差异,不良反应:PBSC动员时出现乏力、恶心共2例次.结论经皮经腔冠状动脉内移植自身PBSC治疗心梗后合并心功能不全病例是安全的,可在近期有效减轻左室重构,改善心功能。更多还原

【Abstract】 Objective To study effects of autologous peripheral blood stem cell transplantation in coronary artery on therapeutic efficacy,security and left ventricular function of heart infarction cases complicating cardiac inadequacy.Methods 53 patients with heart infarction complicating cardiac inadequacy between June 2006 and May 2007 were all chosen to be treated by PCI,and were divided into two groups,23 cases of stem cell transplantation treatment group and 30 cases of control group on whether being treated by stem cell transplantation treatment.The group with stem cell transplantation treatment was consecutively administered granulocyte colony -stimulating factor(G-CSF)by hypodermic to stimulate bone marrow stem cells themselves based on conven- tional treatment(that was drug and interventional therapy)of coronary heart disease for five days,disassociated peripheral blood stem cell suspension on the 6th day,and injected the collecting suspension into infarctus correla- ted artery over foley’s tube for autologous peripheral blood stem cell transplantation.The control group was ad- ministered by conventional treatment of coronary heart disease.Security and adverse reaction were observed dur- ing the mobilization,collection and returning injection of peripheral blood stem cell by coronary artery.The two groups were evaluated in the morphous of aortic ventricle of heart,the change in left ventricular function using ultrasoundcardiogram before and after transplantation in three months,and the index number of segmentation movement of ventricular wall.Survival rate and incidence rate of heart incidents between them were compared. Results Before and after stem cell transplantation in coronary artery until the 6th month,the comparison on sig- nificant decrease in cardiac end-systolic volume(ESV),significant changes in cardiac end-diastolic volume (EDV),significant increase in left ventricular ejection fraction(LVEF)and significant decrease in the index number of segmentation movement of left ventricular wall had statistical difference.The above-mentioned inde- xes had improved but showed no statistical difference for the control group before and after PCI treatment.The a- bove-mentioned indexes had statistics difference between the two groups before and after stem cell treatment. The survival rate and the incidence rate of heart incident had no statistical difference after the operation for 6 month between the two groups.Adverse reaction,debilitation appeared to two case-times while the mobilization of peripheral blood stem cell.Conclusion It was safe for patients with heart infarction complicating cardiac in- adequacy to undergo autologous peripheral blood stem cell transplantation by intracomory infusion.The treatment can mitigate reconstitution of left ventricle and improve heart function in the near future.更多还原