背景：心肌梗死患者出现心室重构及心功能不全是其常见的并发症，老年患者因其自身生理特点上述情况发生可能性更高。近年来干细胞移植治疗急性心肌梗死及心力衰竭成为研究热点，其可行性及安全性已得到证实，但其对于老年患者长期效果尚未明确。 目的：评价自体外周血单个核细胞移植对老年急性心肌梗死患者左室重构和心功能的长期影响。 方法：自2003年8月至2006年8月共入选老年急性心肌梗死患者(年龄≥60岁)30例，分为2组，移植组在常规治疗(药物与介入)基础上经冠状动脉输注自体外周血单个核细胞；对照组经常规方法(药物与介入)治疗。在外周血单个核细胞动员、采集及经冠状动脉回输过程中观察其不良反应。在治疗前及治疗后6，12，24，60个月应用超声心动图评价左室形态及心功能变化。 结果与结论：治疗前两组左室容量及心功能指标比较差异无显著性意义。与治疗前比较，治疗后6，12，24，60个月移植组左室舒张末容积、左室收缩末容积显著降低，左室射血分数显著增高。与治疗前比较，治疗后6，12，24，60个月对照组左室舒张末容积、左室收缩末容积、左室射血分数差异均无显著性意义。与对照组相比较，各个时间点移植组左室舒张末容积、左室收缩末容积均显著降低，左室射血分数增高。随访期间均未发现移植相关不良反应及心血管事件。结果可见自体外周血单个核细胞移植可显著、长期改善老年急性心肌梗死患者的左室重构及心功能情况，且安全性良好。%BACKGROUND:Myocardial infarction patients commonly appear to have left ventricular remodeling and heart failure. Because of physical characteristics, these two complications are more likely to occur in elderly patients with myocardial infarction. In recent years, stem celltransplantation in the treatment of acute myocardial infarction and heart failure has become a hot topic, and the feasibility and safety has been confirmed, but its long-term outcomes in elderly patients are stil unclear. OBJECTIVE:To assess the long-term effect of transplantation of autologous peripheral blood stem cells on the left ventricular remodeling and heart function in the old patients with myocardial infarction. METHODS:Thirty old patients (age ≥ 60 years) with myocardial infarction were randomly assigned to receive intracoronary transplantation of peripheral blood stem cells fol owing bone marrow cells mobilization by granulocyte colony-stimulating factor ( 300-600μg per day) subcutaneously for 5 days in addition to conventional therapy (standard drug therapy and percutaneous coronary intervention;transplantation group, n=15) or standard therapy (standard drug therapy and percutaneous coronary intervention;control group, n=15) . Complications during intervention, left ventricular function and left ventricular remodeling at baseline and 6, 12, 24, 60 months after treatment were monitored. RESULTS AND CONCLUSION:Left ventricular function, left ventricular end diastolic volume, and left ventricular end-systolic volume were significantly improved 6,12, 24, 60 months after autologous peripheral blood stem celltransplantation compared to baseline, while these parameters remained unchanged in the control group. These parameters had statistical difference between the two groups after treatment. During the fol ow-up, no severe side effects were observed. These findings indicate that autologous peripheral blood stem celltransplantation leads to significant and longstanding improvements in left ventricular performance of old patients with myocardial infarction, and shows good safety.
展开▼
