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目的比较自体骨髓单个核细胞(BM-MNC)和内皮祖细胞(EPC)移植对小型猪心肌缺血再灌注损伤后修复梗死心肌和改善心功能的疗效。方法 23头小型猪心肌缺血再灌注损伤模型分为 BM-MNC 组[(3.54±0.90)×10~8个细胞/头,n=9]、EPC 组[(1.16±1.07)×10~7个细胞/头,n=7]以及对照组(n=7),比较细胞移植前以及移植4周时超声心动图、血液动力学和心肌梗死范围的变化。结果与移植前比较,移植4周时 BM-MNC 组、EPC 组左室射血分数(LVEF)分别降低2%[(68±10)%比(66±7)%,P>0.05]和0[(69±7)%比(69±8)%,P>0.05],对照组则降低10%[(70±9)%比(59±7)%,P<0.05],三组间比较差异有统计学意义(P<0.05)。LVEF、左室收缩末压(LVESP)、心输出量(CO)和左室等容收缩压力最大上升速率(+dp/dt_(max))的变化值在 BM-MNC 组和 EPC 组间的差异无统计学意义(P>0.05),而显著小于对照组的变化值(P<0.05)。舒张末压(LVEDP)和等容舒张压力最大下降速率(-dp/dt_(max))在细胞移植前后各组变化不明显(P>0.05)。EPC 和 BM-MNC 移植的心肌梗死面积均小于对照组[心肌梗死面积百分比分别为[(4.1±0.6)%、(8.4±3.8)%和(11.4±3.2)%,均 P<0.05],EPC 组较 BM-MNC 组有减小的趋势,但差异无统计学意义(P=0.067)。结论心肌缺血再灌注损伤后,自体 BM-MNC 和 EPC 移植均可明显改善左室收缩功能,这种作用可能通过减小心肌梗死面积实现。移植 EPC 与 BM-MNC 改善心功能的疗效相当,但还需进一步评价。
Objective To compare the effects of autologous bone marrow mononuclear cells (BM-MNCs) and endothelial progenitor cells (EPCs) transplantation on myocardial infarction and cardiac function in myocardial ischemia-reperfusion injury in miniature pigs. Method 23 Myocardial ischemia-reperfusion injury model was divided into three groups: BM-MNC group [(3.54 ± 0.90) × 10-8 cells / head, n = 9], EPC group (1.16 ± 1.07) × 10-7 Cells / head, n = 7] and control group (n = 7). Echocardiographic, hemodynamic, and myocardial infarction changes were compared before and at 4 weeks after transplantation. Results Compared with those before transplantation, left ventricular ejection fraction (LVEF) in BM-MNC group and EPC group decreased by 2% [(68 ± 10)% vs (66 ± 7)%, P> 0.05] (69 ± 7)% vs (69 ± 8)%, P> 0.05], while the control group decreased by 10% (70 ± 9% vs 59 ± 7%, P <0.05) The difference was statistically significant (P <0.05). The differences of LVEF, LVESP, CO, and maximal rate of increase of left ventricular systolic pressure (+ dp / dt max) in BM-MNC group and EPC group There was no statistical significance (P> 0.05), but significantly less than the control group (P <0.05). The changes of LVEDP and -dp / dtmax were not significantly different before and after cell transplantation (P> 0.05). EPC and BM-MNC transplantation myocardial infarction area were smaller than the control group [infarct size were (4.1 ± 0.6)%, (8.4 ± 3.8)% and (11.4 ± 3.2)%, P <0.05] There was a trend of decrease compared with BM-MNC group, but the difference was not statistically significant (P = 0.067). Conclusion After myocardial ischemia-reperfusion injury, autologous BM-MNC and EPC transplantation can significantly improve left ventricular systolic function, this effect may be achieved by reducing the area of myocardial infarction. The efficacy of transplanting EPC and BM-MNC in improving cardiac function is equivalent, but further evaluation is needed.