背景:心肌缺血再灌注损伤是缺血心肌病及心内直视手术中最常见的并发症之一.骨髓间充质干细胞的发展, 为临床预防与治疗心肌缺血再灌注损伤提供了新的方法.目的:综述骨髓间充质干细胞对心肌缺血再灌注损伤的治疗作用和潜在机制, 旨在为骨髓间充质干细胞指导临床应用提供理论依据.方法:检索中国期刊全文数据库 (CNKI) 、万方、PubMed等数据库2000年1月至2018年10月期间关于骨髓间充质干细胞应用于心肌缺血再灌注损伤的文献, 检索词分别为"骨髓间充质干细胞, 心肌缺血再灌注损伤, 研究进展"和"bone marrow mesenchymal stem cells, myocardial ischaemia/reperfusion, cell therapy, clinical trial studies".排除旧的、重复的观点, 对检索的文献进行整理, 共纳入56篇文献进行分析探讨.结果与结论: (1) 总结了骨髓间充质干细胞治疗心肌缺血再灌注损伤中旁分泌的因子、外泌体miRNA及其作用, 例如抗炎、抗凋亡、抗纤维化、修复心肌和促新生血管等; (2) 总结骨髓间充质干细胞治疗心肌缺血再灌注损伤可能涉及的分子机制, 例如介导线粒体融合蛋白2的作用、心肌自噬调节、AMPK/mTOR信号通路的调节作用; (3) 为骨髓间充质干细胞治疗心肌缺血再灌注损伤指导临床应用提供理论依据.%BACKGROUND: Myocardial ischemia/reperfusion injury is one of the most common complications in ischemic cardiomyopathy and open heart surgery. The development of bone marrow mesenchymal stem cells provides a new method for clinical prevention and treatment of myocardial ischemia/reperfusion injury. OBJECTIVE: To review the therapeutic effect and potential mechanisms of bone marrow mesenchymal stem cells in the treatment of myocardial ischemia/reperfusion injury, in order to provide a theoretical basis for the clinical application of bone marrow mesenchymal stem cells. METHODS: Chinese Journal Full-text Database (CNKI) , WanFang, and PubMed were retrieved for articles related to the use of bone marrow mesenchymal stem cells for myocardial ischemia-reperfusion injury published from January 2000 to October 2018. The search terms were "bone marrow mesenchymal stem cells; myocardial ischaemia/reperfusion; research process" in Chinese and "bone marrow mesenchymal stem cells; myocardial ischaemia/reperfusion; cell therapy; clinical trial studies" in English. Old and repetitive viewpoints were excluded, the searched literatures were sorted out, and finally 56 articles were included for further analysis and discussion. RESULTS AND CONCLUSION: (1) In this paper, we summarize paracrine factors, exosomes miRNA and their effects in the treatment of myocardial ischemia/reperfusion injury with bone marrow mesenchymal stem cells, such as anti-inflammation, anti-apoptosis, anti-fibrosis, repair of myocardium and neovascularization. (2) We also summarize the possible molecular mechanisms of bone marrow mesenchymal stem cells involved in the treatment of myocardial ischemia/reperfusion injury, such as the role of mitochondrial fusion protein 2, regulation of myocardial autophagy, and regulation of AMPK/mTOR signaling pathway. Overall, we attempt to provide a theoretical basis for the clinical application of bone marrow mesenchymal stem cells in the treatment of myocardial ischemia/reperfusion injury.
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