应用要点：采用病例－对照，自身对照观察了外周血干细胞冠脉内移植治疗扩张型心肌病的疗效、安全性及对左室功能的影响，结果显示，外周血干细胞移植近期可改善左室重构，增加患者左室收缩能力，从而改善左室功能。

同行评价：应用干细胞移植治疗原发性扩张型心肌病的研究目前仍较少，特别是临床研究更少，本文采用外周血干细胞移植，受试者分为移植组和对照组，比较两组在移植前及移植后3个月超声心动图的有关指标，并比较两组的生存率及心脏事件发生率，据此，可基本评价移植治疗近期的临床疗效，如能继续观察远期疗效则更有说服力。

相关链接：Orlic等证实骨髓干细胞可促进心肌再生，改善血供和心功能，降低病死率。此后更多研究显示了其独特的优势。近年来，在扩张型心肌病的实验动物中进行细胞移植有了一定的实验基础。有学者将平滑肌细胞和骨骼肌成肌细胞移植到阿霉素诱导的扩张型心肌病动物模型中，发现移植细胞能够在局部存活，并分化为肌管样结构，与宿主心肌纤维紧密排列，增加了室壁张力和弹性，避免心腔过度扩张，虽然移植细胞未能与宿主心肌细胞形成同步收缩，但通过限制心室重构，改善了心功能。

摘要
目的：最近的研究表明，应用干细胞移植有可能取代受损心肌细胞，增加有功能心肌细胞的数量，但检索中文期刊数据库2005~2008年相关文献显示，干细胞移植治疗原发性扩张型心肌病的研究鲜见。观察外周血干细胞冠状动脉内移植治疗扩张型心肌病的疗效、安全性及对左室功能的影响。
方法：选择2006-12/2007-09云南省第一人民医院心内科住院的扩张型心肌病患者42例，男28例，女14例；平均年龄 (56±3)岁。入选标准：年龄 < 65岁；均行冠状动脉造影证实无冠状动脉病变；左室扩大；射血分数 ≤ 45％；患者对治疗知情同意。根据是否行干细胞移植治疗分为干细胞移植组15例及对照组27例，干细胞移植组在常规药物治疗的基础上，应用粒细胞集落刺激因子皮下注射动员自身骨髓干细胞，连用5 d，第6天分离外周血干细胞悬液，将采集后的干细胞悬液经over the wire球囊导管注入左前降支，进行外周血干细胞移植，对照组仅进行常规药物治疗。在外周血干细胞动员、采集及经冠脉回输过程中，观察其安全性及不良反应。在移植前及移植后3个月运用超声心动图评价患者左室形态及心功能指标、室壁节段运动指数，比较两组生存率及心脏事件发生率。
结果：与术前比较，术后3个月干细胞移植组冠状动脉内移植术后心脏收缩末容积明显减小，舒张末容积明显减小，左室射血分数显著增高，左室壁节段运动指数明显减低(P < 0.01)，对照组常规药物治疗后上述指标略有改善，但差异不显著。与对照组比较，干细胞移植组术后心脏收缩末容积、舒张末容积降低、左室射血分数显著增高、左室壁节段运动指数减低(P均 < 0.01)。干细胞移植组未发生急性心力衰竭、心肺复苏等心脏事件，对照组1例发生急性心力衰竭心脏事件，两组术后3个月生存率及心脏事件发生率差异无统计学意义。
结论：经皮经冠状动脉内移植自身外周血干细胞治疗扩张型心肌病是安全的，近期观察可改善心功能，有效减轻左室重构。
关键词：外周血干细胞；扩张型心肌病；心功能；干细胞移植

张彤，刘超，杨俊，张翔，李文.外周血干细胞移植治疗扩张型心肌病42例3个月随访[J].中国组织工程研究与临床康复，2008，12(16):3045-3048 [www.zglckf.com/zglckf/ejournal/upfiles/08-16/16k-3045(ps).pdf]

Peripheral blood stem cell transplantation in the treatment of dilated cardiomyopathy: A 3-month follow-up in 42 cases

Abstract

AIM：Recent studies showed that stem cells could replace injured cardiomyocyte and increase the number of functional cardiomyocytes. Researching the pertinent literature in China Journal Full-text Database (CJFD) published between 2005 and 2008 indicated that the researches on stem cell transplantation in the treatment of primary dilated cardiomyopathy were few. This study investigated the therapeutic efficacy and security of peripheral blood stem cell transplantation in coronary artery in treatment of dilated cardiomyopathy and its effects on left ventricular function.
METHODS: Forty-two patients with dilated cardiomyopathy between December 2006 and September 2007 were enrolled at the Department of Cardiology of First People's Hospital of Yunnan, including twenty-eight males and fourteen females, averagely aged (56±3) years. Inclusive criteria: patients with less than 65 years, left ventricular enlargement, and left ventricular ejection fraction (LVEF) ≤ 45%, and without coronary artery disease after coronary arteriongraphy. Informed consents were obtained from patients. Patients were divided into stem cell transplantation group (n=15) and control group (n=27) on the basis of whether being treated by stem cell transplantation. Patients in the stem cell transplantation group were consecutively administered granulocyte colony-stimulating factor (G-CSF) by hypodermic injection to stimulate bone marrow stem cells themselves based on conventional treatment for five days. Peripheral blood stem cell suspension was disassociated on the 6th day, and the collected suspension was injected into left anterior descending branch over the wire saccule tube for autologous peripheral blood stem cell transplantation. Patients in the control group were administered by conventional treatment of dilated cardiomyopathy. Security and adverse reaction were observed during the mobilization, collection and returning injection of peripheral blood stem cell by coronary artery. Morphous, cardiac function and motion index of left ventricle wall were evaluated using ultrasoundcardiogram before and 3 months after transplantation. Survival rate and incidence rate of heart incidents were compared.
RESULTS: Three months after stem cell transplantation in coronary artery, there were a significant decrease in cardiac end-systolic volume (ESV), cardiac end-diastolic volume (EDV) and motion index of left ventricle wall, but a significant increase in LVEF(P < 0.01). The above-mentioned indexes had improved in the control group without significant differences. Compared to the control group, ESV, EDV and motion index of left ventricle wall were decreased, but LVEF was increased(P < 0.01) in the stem cell transplantation group. No adverse reaction was found such as acute heart failure and cardiopulmonary resuscitation in the stem cell transplantation group. One case developed acute heart failure in the control group. The survival rate and the incidence rate of heart incident had no statistics difference 3 months after the operation between the two groups.
CONCLUSION: It was safe for patients with dilated cardiomyopathy to be treated by autologous peripheral blood stem cell （PBSC）transplantation over coronary artery. The treatment can mitigate reconstitution of left ventricle and improve heart function in the near future.

Zhang T, Liu C, Yang J, Zhang X, Li W.Peripheral blood stem cell transplantation in the treatment of dilated cardiomyopathy: A 3-month follow-up in 42 cases.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(16):3045-3048(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-16/16k-3045(ps).pdf]