肝动脉超选灌注自体骨髓干细胞治疗失代偿期乙型肝炎肝硬化的临床研究

摘要

目的 分析肝动脉超选灌注自体骨髓干细胞对失代偿期乙型肝炎(乙肝)肝硬化患者的疗效及安全性.方法 选择失代偿期乙肝肝硬化患者20例,从髂后上棘抽取骨髓,体外分离纯化骨髓源性干细胞,通过肝动脉超选注入肝脏,在移植后2、4、8、12周复查肝功能,观察实验室指标变化及不良反应情况.同时选取常规治疗的失代偿期乙肝肝硬化患者20例作为对照.结果 治疗组PTA水平自治疗第2周起即出现明显上升,与治疗前比较,差异有统计学意义(P＜0.05).血清ALB从治疗第2周即开始升高,与治疗前比较,差异有统计学意义(P＜0.01),且上升趋势在治疗12周时仍存在.随访结束时,治疗组ALB水平从(26.55±3.24)g/L上升至(31.54±4.2)g/L.CHE水平治疗前后比较差异有统计学意义(P＜0.05).TBIL在治疗后逐步下降,至第12周时下降更为明显(P＜0.05).未发生与干细胞移植相关的并发症.结论 经肝动脉超选自体骨髓干细胞灌注治疗失代偿期乙肝肝硬化安全、有效.%Objective To analyze the efficacy and safety of treatment with superselective hepatic artery infusion of autologous bone marrow stem cells (BMSC) in patients with HBV-related decompensatod cirrhosis. Methods Bone marrow was aspirated from poster superior spine of 20 adult patients with HBV-related decompensated cirrhosis (BMSC treatment group). After isolation and purification in vitro, the stem cells were injected into liver via hepatic artery. The liver function parameters, laboratory parameters and side effects were observed in 2, 4, 8 and 12 weeks after infusion. Another 20 patients with HBV-related decompensated cirrhosis receiving routine therapy were included as the controls (control group). Results The level of prothrombin time activity in the BMSC treatment group obviously increased at week 2 after the infusion of autologous BMSC, and compared with pretherapy, the difference was significant (P＜0.05). The level of serum albumin (ALB) in the BMSC treatment group began to increase at week 2 after the infusion, and compared with pretherapy, the difference was significant (P＜0.01). ALB level kept increasing at week 12 and it increased from (26.55±3.24) g/L to (31.54±4.2) g/L after 12 weeks of follow-up. CHE level in the BMSC treatment group was significanfiy different between pre-and post-therapy (P＜0.05). After the infusion of autologous BMSC, TBIL level decreased gradually, and it was significantly different at week 12 after infusion (P＜0.05). No complications related to stem cell transplantation were found. Conclusions Superselective hepatic artery infusion of autologous BMSC is safe and effective in treatment of patients with HBV-related decompensated cirrhosis.