The clinical study of autologous peripheral blood stem cell transplantation by intracoronory infusion in patients with acute myocardial infarction (AMI)
The clinical study of autologous peripheral blood stem cell transplantation by intracoronory infusion in patients with acute myocardial infarction (AMI)
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DOI：
10.1016/j.ijcard.2006.04.005
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发表时间：
2007-01-31
影响因子：
3.5
通讯作者：
Hu Tie-shi
中科院分区：
文献类型：
--
作者：
Li Zhan-quan;Zhang Ming;Hu Tie-shi
目的：目的探讨自体外周血干细胞（PBSCs）经冠状动脉内移植治疗急性心肌梗死（AMI）的疗效及安全性（标准药物和冠状动脉介入治疗）和PBSC的冠状动脉内移植;另一组为对照组（n = 35），接受最佳的梗死后药物治疗（标准药物和冠状动脉介入治疗）。PBSC移植组接受粒细胞集落刺激因子（G-CSF：非格司亭，300 μ g），剂量为300-600 μ g/天以动员干细胞，G-CSF给药持续时间为5天。第6天，用巴克斯特CS 3000血细胞分离机分离PBSC至悬液57 ml。然后，通过闭塞经导丝球囊并经球囊中心腔灌注动脉，将混悬液转移至梗死相关动脉（伊拉）。对外周血干细胞的动员、分离和冠状动脉内输注过程中的并发症进行了研究。结果：治疗组完成随访35例，对照组完成随访23例。6个月后，在治疗组中，总体左心室功能射血分数（EF）从基线的50.0 ± 8.2%显著改善至57.1 ± 7.8%（P < 0.0001），室壁运动评分指数（WMSI）从1.219 ± 0.190降至1.101 ± 0.118（P < 0.0001），左收缩末期容积（ESV）从63.8 +/- 23.9 ml降至52.6 +/- 20.3 ml（P=0.01），左舒张末期容积（EDV）从134.2 +/- 36.7 ml降至119.2 +/- 30.3 ml对照组治疗后EF、WISM、EDV、ESV无明显改善（P=0.490，0.259，0.117，0.395）。6个月随访后，根据治疗组与对照组，EF从57.1 +/- 7.8显著改善至52.6 +/- 5.7（P = 0.04 1），WISM从1.101 +/- 0.118显著改善至1。184 0.138（P=0.034）。25例患者在外周血干细胞动员、分离和输注过程中发生并发症。与松动相关的并发症发生率为37.1%（13/35），与分离相关的并发症发生率为14.3%（5/35），与冠状动脉内灌注相关的并发症发生率为20.0%（7/35）。结论：自体外周血干细胞经冠状动脉内移植是安全可行的，术后6个月随访可明显改善左心功能。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
Purpose: To investigate the effects and safety of autologous peripheral blood stem cell (PBSCs) transplantation by intracoronory infusion in patients with acute myocardial infarction (AMI).Methods: 70 patients with AMI were allocated to two groups, one was PBSCs transplantation group (n = 35) that received optimal post-infarction medical treatment (standard drug and coronary artery intervention therapy) and intracoronary transplantation of PBSCs; the other was control group (n = 35) that received optimum post-infarction medical treatment (standard drug and coronary artery intervention therapy). The PBSCs transplantation group received granulocyte colony-stimulating factor (G-CSF: Filgrastim, 300 mu g) with the dose of 300-600 mu g/ day to mobilize the stem cell, and the duration of administration G-CSF was 5 days. On the sixth day, PBSCs were separated by Baxter CS 3000 blood cell separator into suspend liquid 57 ml. Then, the suspend liquid was transferred into the infaret-related artery (IRA) by occluding the over-the-wire balloon and infusing artery through balloon center lumen. In the process of the mobilization, separation and intracoronary infusion of PBSCs, the complications have been investigated. Changes in left ventricular function were assessed at 6-month follow-up.Results: 35 cases had finished follow-up in the treated group, while 23 cases in control group. After 6 months, within the treated group, there was a significant improvement in global left ventricular function ejection fraction (EF) from a baseline of 50.0 +/- 8.2% to 57.1 +/- 7.8% (P < 0.0001), wall motion score index (WMSI) from 1.219 +/- 0.190 to 1.101 +/- 0.118 (P < 0.0001), left end-systolic volume (ESV) from 63.8 +/- 23.9 ml to 52.6 +/- 20.3 ml (P=0.01) and left end-diastolic volume (EDV) from 134.2 +/- 36.7 ml to 119.2 +/- 30.3 ml (P=0.07); in the control group, there was no significant improvement in EF, WISM, EDV and ESV (P=0.490, 0.259, 0.117, 0.395). After 6-month follow-up, according to treatment group vs. control group, there was a significant improvement in EF from 57.1 +/- 7.8 to 52.6 +/- 5.7 (P = 0.04 1) and WISM from 1.101 +/- 0.118 to 1. 184 0.138 (P=0.034). There were a total of 25 cases with complications during the mobilization, separating and infusion of PBSC. The incidence of complications relating to mobilization was 37.1% (13/35), relating to separating was 14.3% (5/35) and relating to intracoronary infusion was 20.0% (7/35). No death was observed.Conclusion: Autologous PBSCs transplantation by intracoronary infusion is feasible and safe, and it can improve left ventricular function in the 6-month follow-up. (c) 2006 Elsevier Ireland Ltd. All rights reserved.