中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (1): 6-12.doi: 10.3969/j.issn.2095-4344.2153

• 干细胞移植 stem cell transplantation •    下一篇

脐带间充质干细胞移植治疗缺血性心脏病患者 3 年随访

荆宇澄 1 ，王 乐 1 ，王宪云 2 ，魏 梅 1 ，李 敏 1 ，吉立双 1 ，马芳芳 1 ，刘 刚 1 ，郑明奇 1
  

  1. 河北医科大学第一医院，1 心内科，2 细胞治疗实验室，河北省石家庄市 050031
  • 收稿日期:2019-12-24 修回日期:2019-12-26 接受日期:2020-03-03 出版日期:2021-01-08 发布日期:2020-09-18
  • 通讯作者: 刘刚，博士，主任医师，河北医科大学第一医院心内科，河北省石家庄市 050031 郑明奇，博士，主任医师，河北医科大学第一医院心内科，河北省石家庄市
  • 作者简介:荆宇澄，男，1992 年生，山东省潍坊市人，汉族，2017 年潍坊医学院毕业，医师，主要从事心血管病研究。 王乐，男，1977 年生，河北省石家庄市人，汉族，2015 年河北医科大学毕业，硕士，副主任医师，主要从事心血管病研究。
  • 基金资助:
    河北省科技计划项目(18272405D)；河北省自然科学青年基金项目(C2018206037)；河北省科技支撑计划重点项目(16277707D)；河北省科技计划项目(19277757D)；河北省卫生厅项目(20180224)

Umbilical cord mesenchymal stem cell transplantation in the treatment of ischemic heart disease: a 3-year follow-up

Jing Yucheng1 , Wang Le1 , Wang Xianyun2 , Wei Mei1 , Li Min1 , Ji Lishuang1 , Ma Fangfang1 , Liu Gang1 , Zheng Mingqi1
  

  1. 1 Department of Cardiology, 2 Cell Therapy Laboratory, First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
  • Received:2019-12-24 Revised:2019-12-26 Accepted:2020-03-03 Online:2021-01-08 Published:2020-09-18
  • Contact: Liu Gang, MD, Chief physician, Department of Cardiology, First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China Zheng Mingqi, MD, Chief physician, Department of Cardiology, First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
  • About author:Jing Yucheng, Physician, Department of Cardiology, First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China Wang Le, Master, Associate chief physician, Department of Cardiology, First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China Jing Yucheng and Wang Le contributed equally to this paper.
  • Supported by:
    the Science and Technology Plan Project of Hebei Province, No. 18272405D; the Natural Science Youth Fund Project of Hebei Province, No. C2018206037; the Key Science and Technology Support Plan Project of Hebei Province, No. 16277707D; the Science and Techology Plan Project of Hebei Province, No. 19277757D; the Hebei Health Department Project, No. 20180224

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摘要：

文题释义：
人脐带间充质干细胞：存在于新生儿脐带组织中，具有分化为心肌细胞乃至其他干细胞的能力，目前研究发现干细胞真正分化为心肌细胞的比例过低，其改善心功能主要通过旁分泌作用实现。该类细胞CD90、CD73、CD44(>95%)高表达，主要组织相容性复合物HLA-DR低表达(<5%)，其免疫原性较低，输入后不良反应少见或未见。
左室射血分数：为目前评估心功能的主要指标，其计算方法为：(左室舒张末容积-左室收缩末容积)/左室舒张末容积×100%，正常值> 50%，射血分数下降提示心脏供血不能满足全身代谢需要，表现为心功能下降，主要为冠心病引起，因此射血分数的提高提示心功能改善。
背景：缺血性心脏病的传统治疗方法虽可暂时缓解病痛和改善生活质量，却无法使梗死的心肌修复再生，而干细胞具备的组织再生和多向分化潜能为缺血性心脏病的治疗带来新的契机。脐带间充质干细胞因具备极易分离提取、无免疫排斥、无伦理学争议以及较强的免疫调节作用等优势而成为治疗缺血性心脏病的理想候选种子细胞之一。
目的：探讨人脐带间充质干细胞移植治疗缺血性心脏病3年的临床疗效。
方法：入选2013年1月至2016年6月河北医科大学第一医院收治的冠心病患者8例，随机分为干细胞移植组和对照组，其中干细胞移植组4例行常规治疗并静脉输注人脐带间充质干细胞，对照组4例仅行常规治疗，3年后评估两组患者心功能、生化指标、心电图Ⅱ导联ST段的变化。所有入组患者均签署相关知情同意书，并经河北医科大学第一医院伦理委员会通过。
结果与结论：治疗3年后，两组患者目前均存活。干细胞移植组左室射血分数和短轴缩短率分别较对照组均有升高趋势，但差异无显著性意义(P > 0.05)，干细胞移植组治疗前后左室射血分数和短轴缩短率的差值分别较对照组显著升高(P < 0.05)，两组间心功能分级无显著变化。两组患者生化指标比较差异无显著性意义(P > 0.05)，两组患者治疗前后不同导联心电图ST段的改变不同。该研究仅能表明人脐带间充质干细胞在一定程度上可以改善缺血性心脏病患者的心功能，而对心功能分级、生化指标无明显改善，对心电图各导联的影响不明确，故该治疗方法的意义有待进一步研究。

ORCID:0000-0002-3411-6680(荆宇澄) 

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程


关键词: 干细胞, 脐带间充质干细胞,  缺血性心脏病,  移植,  心功能,  心脏,  随访

Abstract: BACKGROUND: The traditional treatment methods for ischemic heart disease can temporarily relieve pain and improve the quality of life, but cannot restore and regenerate the myocardial tissue. Stem cells have been reported to possess the potential functions of tissue regeneration and multiplex differentiation characteristics which provide a new opportunity for the ischemic heart disease treatment. Because of the unique advantages of umbilical cord mesenchymal stem cells including easy separation, no immune rejection reaction, no ethical dilemmas and remarkable immunomodulatory effect, umbilical cord mesenchymal stem cells have been considered as one of the most ideal candidate seeds for the treatment of ischemic heart disease. 
OBJECTIVE: To investigate the clinical efficacy of umbilical cord mesenchymal stem cells transplantation in patients with ischemic heart disease in 3-year follow-up. 
METHODS: From January 2013 to June 2016, eight patients with coronary heart disease were admitted to the First Hospital of Hebei Medical University and randomly divided into stem cell transplantation group and control group. Four patients in the stem cell transplantation group received conventional treatment and intravenous infusion of umbilical cord mesenchymal stem cells. Four patients in the control group only received conventional treatment. At 3 years after treatment, cardiac function indexes, biochemical indexes and ST segment changes of electrocardiogram lead II were evaluated in two groups. All patients signed the informed consent. The experiment was approved by the Ethics Committee of First Hospital of Hebei Medical University. 
RESULTS AND CONCLUSION: Patients in each group were alive after 3 years. Compared with the control group, left ventricular ejection fraction and left ventricular fraction shortening displayed an increasing trend in the stem cell transplantation group (P > 0.05). The changes of left ventricular ejection fraction and left ventricular fraction shortening indicated an important statistical improvement in the stem cell transplantation group compared with the control group (P < 0.05). There was no significant improvement in New York Heart Association classification between the two groups. The biochemical indicators revealed no significant statistical difference between the two groups (P > 0.05). ST segment changes of different electrocardiogram leads were various before and after treatment in both groups. This study can only show that human umbilical cord mesenchymal stem cells can improve the cardiac function of patients with ischemic heart disease to a certain extent, but there is no significant improvement in the classification of cardiac function, biochemical indicators, and the influence on electrocardiogram leads is not clear. Thus, the significance of this treatment method needs further study. 


Key words: stem cells,  umbilical cord mesenchymal stem cells,  ischemic heart disease,  transplantation,  cardiac function,  heart,  follow-up

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