摘要
目的探索自体骨髓干细胞移植对肝衰竭患者的治疗作用,为干细胞移植的临床应用研究提供基础。方法35例慢性重症肝病患者,20例行自体骨髓干细胞移植治疗,15例作为对照。在无菌条件下,从患者髂后上棘抽取骨髓30～50ml,分离纯化骨髓干细胞。在局部麻醉下行肝动脉介入,将分离的骨髓干细胞移植于肝脏。患者在移植后1、2、4、8周进行肝功能检测。观察患者移植后不同时间症状改善情况及术后不良反应情况。结果在移植8周后,患者丙氨酸转氨酸逐渐降低,由平均181.7μmolL降至72.1μmolL;总胆红素由平均153.8μmolL降至80.2μmolL;直接胆红素由平均74.1μmolL降至40.5μmolL;白蛋白逐渐升高,由平均26.5μmolL升至31.5μmolL;与对照组相比有明显差异,表明移植后患者肝功能明显改善。干细胞移植后凝血酶原活动度逐渐上升,由术前平均28.2%上升至50.1%。进一步观察自体骨髓干细胞移植对肝衰竭患者生存率的影响,发现移植后1周生存率为100%,4周为95%(1920),8周后为90%(1820),12周后为85%(1720),较对照组生存率明显升高。移植后大多数患者有明显症状改善,移植后8周内腹水减轻10例(50%),食欲改善15例(75%),体力好转11例(55%),腹胀减轻9例(45%)。在20例移植患者中未发现严重并发症,术后有轻度恶心1例,发热1例。结论自体骨髓干细胞移植治疗后,患者肝功能和凝血机制明显改善,生存率提高,症状好转,表明骨髓干细胞移植对肝衰竭患者治疗有效,安全,不良反应少。
Objective Recent advances have implicated that bone marrow-derived stem cells could differentiate into hepatocytes and play a important role in the regulation of liver regeneration. In this study we investigated the possibility of treatment for patients with liver failure by transplantation of self-bone marrow derived stem cells. Methods Patients were divided into two groups, the transplant group and control group. Bone marrow was harvested（30-50 ml） from patients in the transplant group. To get the bone marrow stem cells, bone marrow was processed by density gradient sedimentation, the final preparation of BMSC were infused into liver of patients via hepatic artery. At different time （lweek, 2weeks,4weeks, 8weeks） after transplantation, ALT, TBIL, DBIL, ALB, PTA were tested, and the survival rate and improvement of symptom were recorded. Results After transplantation of bone marrow stem cells, the liver function of patients improved. Eight weeks after transplantation, ALT reduced from 181.71 μmol/L to 72.1 μmol/L;TBIL frome 153.1 μmol/L to 80.2 μmol/L;DBIL from 74.1 μmol/L to 40.5μmol/L; ALB elevated from 26.5 μmol/L to 31.5 μmol/L; PTA rose from 28.23 % to 50.1% ; the survival rate of transplant group were higher than that of control group ; symptoms of patients of transplant group were better. Eight weeks after transplantation, ascites decreased in 10 cases（50% ）, appetite improved in 15 cases（75% ）, abdomen distention ameliorated in 9 cases （45 % ） ; no serious events developed in 20 patients with bone marrow stem cells transplantation. Conclusion The liver function of patients with severe liver disease were significantly improved after bone marrow stem cells transplantation,the preliminary results indicate that it is safe and effective.
出处
《肝脏》
2005年第3期171-173,共3页
Chinese Hepatology
