Effect of Granulocyte Colony-Stimulating Factor Treatment at a Low Dose but Long Duration in Patients with Coronary Heart Disease

背景在动物模型中，粒细胞集落刺激因子(G-CSF)可改善梗死后心功能。然而，在对心绞痛和急性心肌梗死(AMI)患者的初步研究中，大剂量的G-CSF经常导致冠状动脉闭塞或再狭窄，而小剂量的G-CSF则没有明显的益处。结果22例顽固性心绞痛患者随机分为G-CSF组和非G-CSF对照组。重组人粒细胞集落刺激因子皮下注射，每日1次，连续10d。外周血白细胞数控制在30,000个/-L左右。一个月后，G-CSF治疗组患者的胸痛症状有所改善。TL-201单光子发射计算机断层扫描(SPECT)显示G-CSF治疗组摄取百分率增加，程度和严重程度评分降低。治疗前外周血中CD34阳性细胞数为0.6个/μL，治疗后上升至3.9个/μL。结论小剂量、长疗程的粒细胞集落刺激因子治疗心绞痛疗效确切，无严重并发症。

BackgroundIn animal models, granulocyte colony-stimulating factor (G-CSF) improves post-infarct cardiac function. However, in pilot studies of the patients with angina and acute myocardial infarction (AMI), G-CSF at a high dose frequently induced coronary occlusion or restenosis, but those at a low dose showed no significant beneficial effect. We hypothesized that a low dose but long duration of G-CSF will have a beneficial effect without serious complications to patients with intractable angina pectoris.Methods and Results22 patients with angina were randomly assigned into G-CSF and non-G-CSF control groups, respectively. Recombinant G-CSF was subcutaneously injected once a day for 10 days. The leukocyte counts in the peripheral blood were controlled at approximately 30,000/□l. One month later, chest pain in the patients improved in the G-CSF-treated group. Tl-201 single photon emission computed tomography (SPECT) revealed the increased %uptake and the reduced extent and severity scores in the G-CSF-treated group. The number of CD34 positive cells in the peripheral blood was 0.6/μl before treatment and increased to 3.9/μl after the therapy.ConclusionsA low dose but long duration of G-CSF treatment may have a beneficial effect without any serious complications in patients with angina pectoris.