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目的 观察经冠状动脉 (冠脉 )自体骨髓单个核细胞 (mononuclearbonemarrowcell,MBMC)移植修复梗死心肌、改善心脏功能的可行性、效果、安全性及不良反应。方法 38例急性心肌梗死 (AMI)患者分为细胞移植组 [常规PCI+细胞移植 (n =2 8) ]和对照组 [常规PCI(n =10 ) ]。随访观察 3个月 ,包括临床、实验室指标、二维超声心动图、正电子发射体层心肌显像 (PET) ,4 8h持续心电监测。梯度密度法分离自体MBMC。PCI+MBMC移植或单纯PCI手术在心肌梗死后平均 14 6d进行。2 1例行超选择性移植 ,经梗死相关冠脉、气囊充盈下高压注入 4× 10 6 个MBMC ,重复注入 6～ 8次。 7例经冠脉选择性移植 ,气囊未充盈下高压注入移植细胞 ,细胞数与上相同。结果 2 8例细胞移植患者手术均安全。 3例于细胞注入后 15～ 30min出现发冷反应 ,半小时后好转 ;3例细胞注入时出现短暂自限性室性早搏 ;术后 4 8h持续心电监测未出现新的心律失常。 15例完成移植后 3个月PET随访观察 ,13例 (13 15 ,86 6 7% )显示原梗死代谢缺损区出现有代谢活力心肌 ,平均占原梗死区 (4 0 0 8±8 82 ) %。超声心动图随访 ,MBMC移植组左室射血分数增加 6 83% (P <0 0 1) ,左室每搏输出量增加18 6 3% (P <0 0 5 ) ;而对照组心功能无改善。结论 本?
Objective To observe the feasibility, efficacy, safety and adverse reactions of coronary artery (coronary) autologous bone marrow mononuclear cells (mononuclear bone marrow cell transplantation) in repairing infarcted myocardium and improving cardiac function. Methods Thirty-eight patients with acute myocardial infarction (AMI) were divided into cell transplantation group (conventional PCI + cell transplantation (n = 28) and control group (conventional PCI (n = 10) Follow-up observation of 3 months, including clinical, laboratory parameters, two-dimensional echocardiography, positron emission tomography (PET), 48h continuous ECG. Gradient separation of autologous MBMC. PCI + MBMC transplantation or PCI alone was performed on average 14 days after myocardial infarction. 21 cases of super-selective transplantation, infarction-related coronary artery, balloon filling under high pressure injection of 4 × 10 6 MBMC, repeated injection 6 to 8 times. Seven patients underwent selective coronary artery transplantation, and the inflated cells were injected under high pressure without filling the balloon. The number of cells was the same as above. Results All the 28 cell transplantation patients were operated safely. 3 cases showed chilling reaction 15-30 minutes after cell injection, and improved after half an hour; 3 cases had short-term self-limiting premature ventricular contractions when the cells were infused; no new arrhythmia was observed after 48 hours. Fifteen patients were followed up for 3 months after the completion of the PET implantation. Thirteen patients (13 15, 86 67%) showed metabolic myocardial viable myocardium, accounting for 40.0% of the original infarct area on average . Echocardiographic follow-up showed that left ventricular ejection fraction increased by 6 83% (P 0 01) and left ventricular stroke volume increased by 18 6 3% (P 0 05) in MBMC transplantation group, while heart function of control group improve. Conclusion?