摘要
目的利用超声心动图评价重度缺血性心力衰竭患者(EIHF)经冠状动脉自体骨髓单个核细胞(MBMC)移植后的心功能改变。方法41例EIHF患者入选,其中的27例接受了经冠状动脉选择性细胞移植,平均MBMC(5.0±0.7)×107。超声心动图对这组患者术前术后的左室功能进行了观测,并与临床表现、实验室检查、正电子体层心肌显像(PET)、心电图的结果相比较。结果27例细胞移植患者均未出现明显的围手术期并发症。细胞移植组:移植术后,该组患者的NYHA分级明显改善(3.4±0.1)级→(2.4±0.2)级(P<0.05),心房利钠肽(ANP)增加,术后第7天为术前1.3倍(P<0.05),PET心肌代谢显像显示代谢活力心肌增加(10.3±3.4)%(P<0.05);超声心动图观察左室射血分数(LVEF)于术后7d、3个月分别较术前增加9.6%(P<0.05)、9.9%(P<0.05),组织多普勒显像(DTI)示二尖瓣环s波、e波明显增大(P<0.05),左室舒张功能指标也有改善的趋势。而对照组3个月心功能检测明显恶化,NYHA分级下降(3.5±0.1)级→(3.9±0.1)级)(P<0.05);LVEF较术前减低7.2%(P<0.001),与细胞移植组相比统计学差异显著(P<0.05)。结论自体MBMC经冠状动脉移植治疗EIHF患者是安全有效的,显著改善了近期预后,而超声心动图可以多角度地观察移植后的治疗效果。
Objective To investigate the effect of the therapy of end-stage ischemic heart failure by intracoronary autologous mononuclear bone marrow cell （MBMC） transplantation in patients with end-stage ischemic heart failure（EIHF） with echocardiography. Methods Forty-one patients with EIHF were enrolled in this study, in which 27 patients were transplanted with autologous MBMC [average MBMC（5.0±0.7）× 107] via infarct-related coronary artery by balloon catheter. Baseline and follow up observations were recorded by ultrasonography, which were compared with the results of clinical and laboratory evaluations, PET, ECG monitoring. Results There were no major periprocedural complications. In cell group, after surgery, NYHA class became from （3.4±0.1）→（2.4±0.2） （P〈0.05）; levels ofANP rised, which was as 1.3 time as that before surgery（P〈0.05） in 7 days, FDG-PET analysis revealed a significant increase [（10.3±3.4）%, P〈0.05] than those before cell transplantation, respectively; on echocardiography, LVEF increase 9.6% （P〈0.05）, 9.9% （P〈0.05） in 7 days and 3 months than before surgery, respectively; velocities of s-wave and e-wave on DTI at the 6 sites of mitral annuli increased（P〈0.05, respectively）; a tendency of LV diastolic function having been improved was also noticed. In control group, 3 month of follow up, the cardiac function became worse; NYHA class became from （3.5±0.1）→（3.9±0.1） （P〈0.05）; LVEF decreased 7.2% （P〈0.05）, which was significant difference compared with cell transplantation group（P〈0.05）. Conclusions Present study demonstrates that intracoronary transplantation of autologous MBMC is safe and effective in patients with sever ischemic heart failure. Echocardiogram can observe the marked therapeutic effects from multi-views.
出处
《中国医药指南》
2010年第6期23-25,52,共4页
Guide of China Medicine
关键词
骨髓祖细胞
心力衰竭
冠状动脉疾病
超声心动图
Bone marrow progenitor cell
Heart failure
Coronary heart disease
Ultrasonography
