Portal vein embolization and autologous CD133+ bone marrow stem cells for liver regeneration:: Initial experience
Portal vein embolization and autologous CD133+ bone marrow stem cells for liver regeneration:: Initial experience
复制标题
DOI：
10.1148/radiol.2431060625
复制
发表时间：
2007-04-01
期刊：
影响因子：
19.7
通讯作者：
Knoefel, Wolfram T.
中科院分区：
文献类型：
--
作者：
Fuerst, Guenter;Esch, Jan Schulte am;Knoefel, Wolfram T.
目的：前瞻性评价门静脉栓塞（PVE）和CD13（+）骨髓干细胞（BMSC）给予肝脏与单独PVE相比，在促进大型肝脏恶性肿瘤患者肝脏再生方面的有效性。材料与方法：本研究经机构伦理委员会批准；获得知情同意。13例患者在扩大右肝切除术前接受肝段I和IV-VIII的PVE以刺激肝再生。6例患者（3男3女，平均年龄61岁，范围46 - 72岁）未来肝残量（FLRV）低于25%和/或肝实质质量有限，单靠PVE不能保证足够的增殖。这些患者接受BMSC给药至II节段和III节段（I组）。7例FLRV低于25%的患者（3男4女，平均年龄69岁，范围63 - 75岁）单独行PVE治疗（II组）。两名放射科医生不知道病人的身份和彼此的结果，用螺旋计算机断层扫描测量肝脏和肿瘤体积。使用t检验或Wilcoxon检验比较绝对、相对和每日FLRV增益。结果：ⅰ组的平均绝对FLRV从239.3 mL +/- 103.5（标准差）增加到417.1 mL +/- 150.4，显著高于ⅱ组的286.3 mL +/- 77.1到395.9 mL +/- 94.1 （P = 0.049）。ⅰ组PVE后FLRV相对增益（77.3% +/- 38.2）显著高于ⅱ组（39.1% +/- 20.4）（P = 0.039）。ⅰ组肝脏日生长率（9.5 mL/d +/- 4.3）显著优于ⅱ组（4.1 mL/d +/- 1.9） （P = 0.03）。手术时间I组为27天+/- 11天，II组为45天+/- 21天（P = 0.057）。结论：在肝脏恶性病变患者中，PVE联合CD133 +/- BMSC治疗与单独使用PVE相比，可显著增加肝脏再生。
Purpose: To prospectively evaluate the effectiveness of portal vein embolization (PVE) and CD13(+) bone marrow stem cell (BMSC) administration to the liver, compared with PVE alone, to augment hepatic regeneration in patients with large hepatic malignancies.Materials and Methods: The study was approved by the institutional ethics committee; informed consent was obtained. Thirteen patients underwent PVE of liver segments I and IV-VIII to stimulate hepatic regeneration prior to extended right hepatectomy. In six patients (three men, three women; mean age, 61 years; range, 46 - 72 years) with a future liver remnant volume (FLRV) below 25% and/or limited quality of hepatic parenchyma, PVE alone did not promise adequate proliferation. These patients underwent BMSC administration to segments II and III (group I). In seven patients (three men, four women; mean age, 69 years; range, 63 - 75 years) with an FLRV below 25%, PVE alone was performed (group II). Two radiologists blinded to patients' identity and each other's results measured liver and tumor volumes with helical computed tomography. Absolute, relative, and daily FLRV gains were compared by using the t test or the Wilcoxon test.Results: The increase of the mean absolute FLRV in group I from 239.3 mL +/- 103.5 (standard deviation) to 417.1 mL +/- 150.4 was significantly higher than that from 286.3 mL +/- 77.1 to 395.9 mL +/- 94.1 in group II (P = .049). The relative gain of FLRV after PVE in group I (77.3% +/- 38.2) was significantly higher than that in group II (39.1% +/- 20.4) (P = .039). The daily hepatic growth rate in group I (9.5 mL/d +/- 4.3) was significantly superior to that in group II (4.1 mL/d +/- 1.9) (P = .03). Time to surgery was 27 days +/- 11 in group I and 45 days +/- 21 in group II (P = .057).Conclusion: In patients with malignant liver lesions, the combination of PVE with CD133 +/- BMSC administration substantially increased hepatic regeneration compared with PVE alone.