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背景:有动物实验表明移植心肌梗死区的骨髓干细胞可以定向分化为具有正常生理功能的心肌细胞并可促进新生血管形成,达到修复梗死心肌,改善受损的心脏功能。目的:观察自体骨髓干细胞移植对缺血性心肌病心力衰竭患者近期心功能的影响。设计:自身前后对照。单位:湘潭市中心医院心内科。对象:选择2004-03/2006-01在湘潭市中心医院心内科收治的21例缺血性心肌病患者,男13例,女8例,平均(64±6)岁,纳入标准:既往至少患过1次心肌梗死,心脏B超提示心腔扩大,支架置入前存在明显的心功能不全或心绞痛且反复住院,均已成功完成经皮腔冠状动脉介入治疗且梗死血管血流恢复至TIMI3级达3月以上,尚存在不同程度心功能不全。冠状动脉造影显示冠脉内支架均无狭窄。患者均对手术项目知情同意。方法:患者入院后在常规药物治疗的基础上予骨髓干细胞移植,经皮腔导管技术建立梗死相关动脉通道,利用球囊封闭梗死相关动脉通道,并将分离的骨髓干细胞悬液经导管中心腔注入梗死相关动脉通道。①分别于移植前和移植后6月测量左室射血分数、左室舒张末内径。②移植前及移植后6月在未服抗心律失常药物的前提下,分别行24h动态心电图评估。③对患者移植前及移植6月后临床心功能分级评定,采用NYHA分级方法,Ⅰ￣Ⅳ级:级数越高,症状越严重。④观察术后不良事件和副反应。主要观察指标:①移植前和移植后6月测左室射血分数、左室舒张末内径。②24h动态心电图评估结果。③临床心功能分级评定结果。④术后不良事件和副反应。结果:纳入21例患者全部进入结果分析。①骨髓干细胞移植6个月后患者左室射血分数大于移植前[(54.4±6.2)%,(44.6±6.4)%,t=-5.946,P<0.01],左室舒张末内径小于移植前[(54.6±4.2),(60.2±4.4)mm,t=5.306,P<0.01]。②患者未出现新的心律失常类型,亦无恶性心律失常增多。③骨髓干细胞移植6月后,心功能Ⅲ、Ⅳ级患者共9例,而移植前为18例。④移植术中、术后均安全,无因胸痛复查冠脉造影显示支架内狭窄患者,未出现死亡病例。结论:经皮腔冠状动脉内移植骨髓干细胞治疗缺血性心肌病可行,术后能提高左室射血分数,心功能改善。
BACKGROUND: Animal experiments show that bone marrow stem cells transplanted in myocardial infarction area can be differentiated into cardiomyocytes with normal physiological functions and promote neovascularization to repair infarcted myocardium and improve impaired cardiac function. Objective: To observe the effect of autologous bone marrow stem cell transplantation on cardiac function in patients with ischemic cardiomyopathy and heart failure. Design: self-control. Unit: Xiangtan Central Hospital Department of Cardiology. PARTICIPANTS: Twenty-one patients with ischemic cardiomyopathy who were admitted to Department of Cardiology, Xiangtan Central Hospital from March 2004 to January 2006 were selected, including 13 males and 8 females, with an average of (64 ± 6) years. Inclusion criteria were as follows: After a myocardial infarction, cardiac B-mode prompt expansion of the heart chamber, there was significant cardiac insufficiency or angina pectoris before hospitalization and repeated hospitalizations. All patients underwent percutaneous coronary intervention and the infarcted vessel blood flow was restored to TIMI level 3 Up to March, there are still varying degrees of cardiac insufficiency. Coronary angiography showed no stenosis in coronary stents. Patients were informed of the surgical items. Methods: The patients were admitted to hospital on the basis of conventional medical therapy to bone marrow stem cell transplantation, percutaneous catheterization of infarct-related artery access, the use of balloon occlusion of infarct-related artery access, and the isolated bone marrow stem cell suspension by the catheter into the central cavity Infarct-related artery access. ① Left ventricular ejection fraction and left ventricular end-diastolic diameter were measured before and after transplantation respectively. ② Pretransplant and post-transplantation in June under the premise of not taking anti-arrhythmic drugs, 24h dynamic electrocardiogram were assessed. (3) The grading of clinical heart function before transplantation and 6 months after transplantation was performed by NYHA classification method, Ⅰ ~ Ⅳ grade: the higher the grade, the more severe the symptoms. ④ observe postoperative adverse events and side effects. MAIN OUTCOME MEASURES: ① Left ventricular ejection fraction and left ventricular end-diastolic diameter before and 6 months after transplantation. ② 24h Holter assessment results. ③ classification of clinical cardiac function assessment results. ④ postoperative adverse events and side effects. RESULTS: Twenty-one patients were included in the result analysis. ① The left ventricular ejection fraction after 6 months of bone marrow stem cell transplantation was significantly higher than that before transplantation [(54.4 ± 6.2)%, (44.6 ± 6.4)%, t = -5.946, P <0.01] [(54.6 ± 4.2), (60.2 ± 4.4) mm, t = 5.306, P <0.01]. ② patients did not appear new type of arrhythmia, no increase in malignant arrhythmia. ③ After 6 months transplantation of bone marrow stem cells, there were 9 patients with cardiac function Ⅲ, Ⅳ grade, and 18 patients before transplantation. ④ transplantation, postoperative were safe, no review of chest pain due to coronary angiography showed stent stenosis, no deaths. Conclusion: Transplantation of percutaneous transluminal bone marrow stem cells in treatment of ischemic cardiomyopathy is feasible. Postoperative left ventricular ejection fraction can be improved and heart function improved.