中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (1): 121-125.doi: 10.3969/j.issn.1673-8225.2010.01.026

• 干细胞移植 • 上一篇    下一篇

自体外周血干细胞移植治疗扩张型心肌病：38例24个月随访

吴朝晖1，袁明远1，李海苗1，邱京晶1，劳汉珠1，吴祥元2，林金香2   

  1. 1武警广东总队医院心内科，广东省广州市  510507；
    2中山大学附属第三医院血液科，广东省广州市  510630
  • 出版日期:2010-01-04 发布日期:2010-01-04
  • 作者简介:吴朝晖，男，1965年生，湖北省赤壁市人，汉族，1998年中山医科大学毕业，硕士，副主任医师，主要从事干细胞治疗心肌病方面的研究。 zhwugz@yahoo.com.cn

Autologous peripheral blood stem cells transplantation for the treatment of dilated cardiomyopathy: A 24-month follow-up in 38 cases

Wu Zhao-hui1, Yuan Ming-yuan1, Li Hai-miao1, Qiu Jing-jing1, Lao Han-zhu1, Wu Xiang-yuan2, Lin Jin-xiang2   

  1. 1Department of Cardiology, Guangdong General Hospital of Chinese People’s Armed Police Forces, Guangzhou  510507, Guangdong Province, China;
    2Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou  510630, Guangdong Province, China
  • Online:2010-01-04 Published:2010-01-04
  • About author:Wu Zhao-hui, Master, Associate chief physician, Department of Cardiology, Guangdong General Hospital of Chinese People’s Armed Police Forces, Guangzhou 510507, Guangdong Province, China zhwugz@yahoo.com.cn

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摘要：

目的：评价动员后自体外周血干细胞经冠状动脉移植治疗扩张型心肌病的远期临床疗效和安全性。

方法：选择2004-03/2006-10武警广东省总队医院心内科收治的扩张型心肌病患者38例，男26例，女12例，年龄42~72岁，平均56岁。随机分为移植组(n=20)和对照组(n=18)，两组均予常规药物治疗，其中移植组患者予重组人粒细胞集落刺激因子300 μg皮下注射，1次/d，进行自体外周血干细胞动员，第6天用血细胞分离机分离自体外周血干细胞，进行经皮经腔冠状动脉内移植；对照组：仅行常规药物治疗，未进行细胞移植。两组患者于移植前和移植后6，12个月分别检测血常规及生化指标(肝功能、肾功能、血糖、血脂、血尿酸、肌酸激酶、肌酸激酶同工酶和高敏C-反应蛋白)的变化；移植前和移植后12，24个月分别行超声心动图、动态心电图、6 min步行试验。比较两组生存率及心脏事件发生率，以患者死亡作为试验终点。

结果：两组患者均获得随访，平均随访(18±6)个月，在随访12~24个月时移植组患者1例行二尖瓣置换，1例死亡，对照组2例死亡，均死于顽固性心衰。移植组患者移植后6，12个月血常规及生化各指标与移植前及对照组相比，差异均无显著性意义(P > 0.05)。移植后12个月，移植组6 min步行路程较移植前明显增加，与对照组和自身移植前相比，差异均具有显著性意义(P < 0.05)；超声检查显示左心室射血分数较移植前及对照组明显增加(P < 0.01)。左心室舒张末内径也较移植前及对照组明显降低(P < 0.01)。对照组的左心室射血分数及左心室舒张末内径虽然较12个月前有所改善，但差异无显著性意义(P > 0.05)。随访至24个月，上述指标未见进一步改善，且有转差趋势。围移植期及移植后24个月随访中未见任何严重心律失常等不良反应发生。随访期间两组患者生存率无显著性意义。

结论：采用动员后的自体外周血干细胞移植治疗扩张型心肌病安全、有效，近期可显著改善左心室收缩功能，但远期临床效果尚不肯定。

关键词: 细胞移植, 扩张型心肌病, 心功能, 外周血干细胞, 干细胞

Abstract:

OBJECTIVE: To identify long-term outcomes and safety of transplantation of autologous peripheral blood stem cells (PBSC) for treating dilated cardiomyopathy.

METHODS: A total of 38 cases with dilated cardiomyopathy received treatment at the Department of Cardiology, Guangdong General Hospital of Chinese People’s Armed Police Forces, were selected, including 26 males and 12 females, aged 42-72 years, mean aged 56 years. Based on given standard therapy, 38 patients divided randomly into the transplantation group (n=20) and the control group (n=18). Patients in the transplantation group were received recombinant human granulocyte colony-stimulating factor (rhG-CSF) 300 ug/d once per day for 5 days to mobilize stem cells. At day 6, PBSC were collected with blood-cells separator and were transplanted through intracoroary way. The routine medication was performed in the control group. Blood routine test, hepatic function, renal function, glucose, triglyeride (TG), cholesterol, low density cholesterol (C-LDL), high density cholest- erol (C-HDL), uric acid (UA), creatine kinase (CK), isoenzyme of creatine kinase (CK-MB) and high sensitive C-reactive protein (hsCRP) were measured before and at months 6 and 12 after transplantation. All patients also received ultrasonic echocardiography, ECG Holter monitor and six-minute-walk test before and at 12 and 24 months after the procedure. Survival rate and incidence rate of heart incidents were compared. The study end-point was death from any cause.

RESULTS: All patients received a 12-24 month follow-up with mean (18±6) months. One patient in the transplantation group received mitral valve replacement. One patient of the transplantation group and 2 of the control group died due to refractory heart failure. The blood routine test and biochemical indicators of the transplantation group had no significant differences among 6 months and 12 months after transplantation compared with control and pre-transplantation (P > 0.05). Six-minute-walking distance in the transplantation group significantly increased at 12 months after transplantation than pre-transplantation level, which was also higher than that of control patients (P < 0.05). The left ventricular ejection fraction (LVEF) was increased (P < 0.01). The left ventricular diastolic diameter (LVDd) decreased significantly in the transplantation group (P < 0.01). In the control group, improvement in LVEF and LVDd were observed, but there was no significant difference (P > 0.05). After 24 months of follow-up, the above-mentioned indexes had not improved in the transplantation group without significant differences. No malignant arrhythmias and severe side effects could be observed around transplantation and during 24 months follow-up. Survival was similar between the two groups during 24 months follow.

CONCLUSION: Transplantation of mobilized autologous PBSC might be a safe and effective method for the treatment of dilated cardiomyopathy, which may improve the ventricular systolic function in a short-term, however, the long-term effects still uncertain

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