人脐带血干细胞经外周静脉、肝动脉移植治疗失代偿期肝硬化的患者近期疗效观察

摘要

目的：比较人脐带血干细胞经外周静脉、肝动脉移植治疗失代偿期肝硬化的患者近期疗效。方法将该院2010年1月-2014年4月收治的40例肝硬化失代偿期患者随机分成两组，每组20例。在内科综合治疗的基础上，分别经外周静脉和经股动脉穿刺至肝固有动脉，移植相同数量的人脐带血干细胞，观察两组患者术后临床症状变化，检测术后2、4、8和12周患者血清总胆红素（TBIL）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、血清白蛋白（ALB）、胆碱酯酶（CHE）、凝血酶原时间（PT）水平。结果两组在治疗后2周左右患者临床症状改善，术后4周两组总胆红素、ALT、AST开始逐渐下降，血清白蛋白、胆碱酯酶逐渐上升，凝血酶原时间缩短，与术前比较差异有统计学意义。但外周静脉移植组各检测指标在术后8周与术后12周比较差异无统计学意义。经肝动脉组患者总胆红素、ALT、AST、血清白蛋白等指标改善呈时间依赖性，至术后12周时最明显，而凝血酶原时间术后8周和12周差异无统计学意义。结论经外周静脉、肝动脉移植人脐带血干细胞治疗肝硬化失代偿期患者近期疗效确切，且经肝动脉移植人脐带血干细胞有时间依赖性。%Objective To determine and compare the short-term effect of human umbilical cord blood stem cell transplantation on the decompensated cirrhosis via peripheral veins or heptic artery. Methods Forty patients with decompensated cirrhosis from 2010 to 2014 were randomly divided into peripheral-vein group and hepatic-artery group, and each group had 20 cases. They were injected with the same amount of human umbilical cord blood stem cells via peripheral veins or heptic artery on the basis of comprehensive medicine treatment. The changes in clinical symptoms of the patients were observed. The levels of serum bilirubin, ALT, AST, albumim, cholinesterase and prothrombin time were determined 2, 4, 8 and 12 weeks after cell transplantation. Results The clinical symptoms of the patients in both groups were all improved 2 weeks after cell transplantation. The levels of serum bilirubin, ALT and AST decreased; albumim and cholinesterase in-creased; and prothrombin time was shortened 4 weeks after transplantation; which were statistically dffferent from the preoperative levels. The changes between 8 weeks and 12 weeks after transplantation had no statisti-cal dffferences in the peripheral-vein group. The serum bilirubin, ALT, AST and albumim were improved in a time-dependent manner, and most significantly 12 weeks after cell transplantation. The prothrombin time 8 weeks after transplantation had no statistical dffference from that 12 weeks after transplantation. Conclusions The transplantation of human umbilcal cord stem cells has short-term efficacy in patients with decompensated cirrhosis, and its efficacy in heptic-artery group is time-dependent.