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目的:探讨急性心肌梗死患者自体骨髓单个核细胞经冠状动脉移植的安全性和对心功能的保护作用。方法:2003年3月以来,84例急性心肌梗死患者急诊静脉溶栓或急诊经皮冠状动脉成形术(PTCA)加支架治疗后2周内行择期冠状动脉造影或PTCA加支架治疗,其中50例抽取骨髓40ml,提取单个核细胞,经冠状动脉注入,另34例不做自体骨髓单个核细胞经冠状动脉移植,作为对照组。81例患者术前和术后6个月、2年均行多巴酚丁胺负荷试验(另3例未完成超声心动图随访观察)。结果:治疗组患者临床随访无明显不良反应,心功能明显改善,运动耐量增加。多巴酚丁胺负荷试验左室射血分数(LVEF)和室壁运动记分指数(WMSI)显著改善,峰值LVEF和WMSI与基础状态LVEF和WMSI的差值在治疗前后相比,与对照组相比均差异有统计学意义。结论:自体骨髓单个核细胞经冠状动脉移植治疗急性心肌梗死患者,经6个月～2年的临床观察无明显不良反应,具备安全性,多巴酚丁胺负荷试验显示出自体骨髓单个核细胞治疗对梗死后心功能有保护作用。
Objective: To investigate the safety and cardiac function of autologous bone marrow mononuclear cells transplanted by coronary artery in patients with acute myocardial infarction. Methods: From March 2003, 84 patients with acute myocardial infarction underwent emergency coronary thrombolysis or emergency percutaneous transluminal coronary angioplasty (PTCA) plus stent treatment within 2 weeks after elective coronary angiography or PTCA plus stent treatment, of which 50 cases of extraction Bone marrow 40ml, extracted mononuclear cells, the coronary artery injection, the other 34 cases of autologous bone marrow mononuclear cells without coronary artery transplantation, as a control group. 81 patients underwent dobutamine stress test two months before surgery and 6 months after surgery (the other 3 patients did not complete echocardiography follow-up observation). Results: The patients in the treatment group had no obvious adverse reactions in clinical follow-up, heart function improved obviously and exercise tolerance increased. Compared with the control group, the left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) in the dobutamine stress test significantly improved, and the differences between the peak LVEF and WMSI and the baseline LVEF and WMSI before and after treatment All the differences were statistically significant. CONCLUSIONS: Autologous bone marrow mononuclear cells transplanted in patients with acute myocardial infarction after coronary artery transplantation have no adverse reactions after 6 months to 2 years of clinical observation and are safe. The dobutamine stress test shows that autologous bone marrow mononuclear cells Treatment of heart function after infarction have a protective effect.