摘要
背景：移植干细胞可以分化形成心肌细胞、血管内皮细胞改善心脏功能。但有些学者认为干细胞移植会加重梗死心肌的炎症反应及内皮功能不全，从而增加支架内再狭窄的发生率。目的：观察骨髓间充质干细胞移植后急性心肌梗死患者血清可溶性细胞间黏附分子1、可溶性血管内皮细胞黏附分子1、可溶性E-选择素含量的变化，评价干细胞移植的安全性。设计、时间及地点：随机对照临床试验，于2006—06／2007—06在唐山市工人医院完成。对象：急性前壁心肌梗死患者40例，随机分为2组：干细胞移植组20例，男12例，女8例，平均年龄（63．7±10.2）岁；单纯经皮冠状动脉介入组20例，男11例，女9例，平均年龄（65．3±11．5）岁。选取20名健康体检者作为正常对照组，男10名，女10名，平均年龄（62．4±10．7）岁。方法：干细胞移植组患者急诊行经皮冠状动脉介入治疗开通罪犯血管后7～10d行干细胞移植术，单纯经皮冠状动脉介入组患者急诊经皮冠状动脉介入治疗开通罪犯血管，未行干细胞移植。主要观察指标：采用ELISA法测定急诊经皮冠状动脉介入前、干细胞移植术后及术后1，3，6月患者血清中可溶性细胞间黏附分子1、可溶性血管内皮细胞黏附分子1、可溶性E-选择素的变化。结果：随访6个月中，干细胞移植组与单纯经皮冠状动脉介入组炎性因子表达量均呈下降趋势。术后1，3，6月干细胞移植组可溶性细胞间黏附分子1均低于单纯经皮冠状动脉介入组（P〈0．05）；术后1，3月干细胞移植组可溶性血管内皮细胞黏附分子1均低于单纯经皮冠状动脉介入组（P〈0．05），术后6个月两组间比较差异不显著（P〉0．05）；术后1，3月干细胞移植组可溶性E-选择素与单纯经皮冠状动脉介入组比较差异无显著性意义（P〉0．05），术后6个月干细胞移植组低于单纯经皮冠状动脉介入组（P〈0．05），说明干细胞移植组下降更为显著。结论：骨髓间充质千细胞移植治疗心肌梗死较安全，不会加重炎性反应及血管内皮功能损伤，相反可能会带来有益影响。
BACKGROUND： The transplanted stem cells can differentiate into myocardial cells and vascular endothelial cells, and improve heart function. But some researchers insist that stem cell transplantation may make the endothelial dysfunction worse, make the rate of in-stent restenosis higher, because it aggravates the inflammatory reaction. OBJECTIVE： To explore the effect of bone marrow mesenchymal stem cell transplantation on serum soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1 and soluble E-selectin contents in acute myocardial infarction patients and to assess the safety of stem cell transplantation. DESIGN,TIME AND SETTING： The randomized control clinical experiment was performed at the Tangshan Worker＇s Hospital from June 2006 to June 2007. PARTICIPANTS： Forty patients of acute anterior wall myocardial infarction were divided into 2 groups. Stem cell transplantation group （n=20） included 12 males and 8 females, averagely （63.7±10.2） years in age. Simple percutaneous coronary artery intervention group （n=20） contained 11 males and 9 females, averagely （65.3±11.5） years in age. We also selected 20 healthy persons, who had health examination, as normal control group, which was composed of 10 males and 10 females, averagely （62.4±10.7） years in age. METHODS： Patients in the stem cell transplantation group received percutaneous coronary artery intervention, and then underwent stem cell transplantation after opening the culprit vessels for 7-10 days. Patients in the simple percutaneous coronary artery intervention group were subjected to percutaneous coronary artery intervention to open culprit vessels. MAIN OUTCOME MEASURES： Serum soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1 and soluble E-selectin contents were measured by enzyme-labeled immunosorbent assay （ELISA） before percutaneous coronary artery intervention in emergency, immediately, 1,3, 6 months after stem cell transplantation. RESULTS： In the following 6 months, the levels of inflammatory cytokines descended in the stem cell transplantation and simple percutaneous coronary artery intervention groups. Soluble intercellular adhesion molecule-1 levels were lower in the stem cell transplantation group than in the simple percutaneous coronary artery intervention group 1, 3 and 6 months after surgery （P 〈 0.05）. Soluble vascular cell adhesion molecule-1 levels were lower in the stem cell transplantation group than in the simple percutaneous coronary artery intervention group 1, 3 months after surgery （P 〈 0.05）, but no significant difference was detected at month 6 after surgery （P 〉 0.05）. There was no significant difference in soluble E-selectin contents between stem cell transplantation group and simple percutaneous coronary artery intervention group 1, 3 months after surgery （P 〉 0.05）, but the soluble E-selectin contents were lower in the stem cell transplantation group than in the simple percutaneous coronary artery intervention group at month 6 after surgery （P 〈 0.05）, which indicated that the reduction was more significant in the stem cell transplantation group. CONCLUSION： Bone marrow mesenchymal stem cell transplantation for myocardial infarction is safe, and does not aggravate the inflammation reaction or vascular endothelial dysfunction, but will make beneficial on them.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第38期7443-7446,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
国家高技术研究发展计划(863)(2005AA205232)~~
