经静脉和冠状动脉自体骨髓干细胞移植治疗急性心肌梗死的临床研究

摘要

Objective To evaluate the effect of autologous bone marrow stem cell ( MSCs) transplantation in acute myocardial infarction (AMI) with different transplantation methods. Methods Thirty patients with AMI included in the cardiology department of our hospital were divided into 3 groups,with 10 cases in each group. Patients in Group 1 underwent percutaneous coronary intervention (PCI) ,Group 2 intravenous transplantation of autologous artery bone MSCs after PCI ,and Group 3 intracoronary transplantation of autologous artery bone MSCs after PCI. Echocardiogram,single photon emission computed tomography and Six -Minute Walk Test were carried out between transplantation and discharge . Results The heart function of patients was improved significantly in both Group 2 and 3(P < 0.05 ) ,while not in Group 1 (P > 0.05). Difference between Group 2 and 3 was not significant (P > 0.05). The single photon emission computed tomography (SPECT) demonstrated significant improvement in myocardial metabolism imaging after transplantation of MSCs in Group 2 and 3. Six-Minute Walk Test results elevated significantly six months after MSCs transplantation compared with pre -transplantation (P < 0.05 ). But the changes between Group 2 and 3 were not significantly different ( P > 0.05 ). Conclusions Autologous bone MSCs transplantation for AMI is safe and effective . Intravenous and intracoronary transplantation show no statistically signifi -cant difference in curative effect.%目的 比较不同输入途径对骨髓干细胞(Bone Marrow Stem Cells,MSCs)移植治疗急性心肌梗死(Acute Myocardial Infarction,AMI )效果的影响.方法 入选我院心内科 AMI 住院患者 30 例分成 3 组,每组 10 例.1 组单纯经皮冠状动脉 介入术(Percutaneous Coronary Intervention,PCI),2 组 PCI 后经静脉行 MSCs 移植,3 组 PCI 后经冠脉行 MSCs 移植.出院前及 移植后定期复查心脏彩超、心肌单光子发射计算机断层扫描(Sigle-photon Emission Computed Tomography,SPECT)及 6 分钟步 行试验.结果 ①心脏彩超显示三组术后心功能均好转,术后 6 月与移植前比较差异有统计学意义(P ＜0.05);经静脉 MSCs 移植组与单纯 PCI 组差异有统计学意义(P ＜0.05);经冠脉 MSCs 移植组与单纯 PCI 组差异有统计学意义(P ＜0.05);经静脉 与冠脉 MSCs 移植组间差异无统计学意义(P ＞0.05);②SPECT:单纯 PCI 组术后无明显变化,静脉移植组及经冠脉移植组心 肌灌注显像明显改善;③6 分钟步行试验:3 组术后 6 月皆明显改善(P ＜0.05),经静脉 MSCs 移植组及经冠脉移植组间比较 差异无统计学意义(P ＞0.05).结论 MSCs 移植治疗 AMI 安全、有效,经静脉和冠状动脉移植的疗效无显著差别.