摘要
目的观察经肝固有动脉行自体骨髓间充质干细胞(BMSC)移植治疗失代偿期肝硬化的疗效及其安全性。方法将2012年6至2013年6月解放军第五三三医院肝病科收治的84例失代偿期患者随机分为移植组36例和对照组48例。对照组予以基础治疗(护肝、降黄、对症和支持治疗),移植组在基础治疗上行经肝固有动脉注入自体BMSC治疗。观察两组丙氨酸氨基转移酶(ALT)、白蛋白(Alb)、总胆红素(TBil)、凝血酶原时间(PT)、终末期肝病模型评分(MELD)的变化情况,分别在4、12、24、48周进行随访;两组肝功能指标比较用独立t检验,治疗后不同时间各肝功能指标的比较用F检验及LSD两两检验,两组之间肝癌发生率和病死率比较应用四格表χ2检验。结果治疗4周后,移植组腹水消退15例(41.7%),腹胀减轻21例(58.3%),下肢水肿减轻13例(36.1%),对照组分别为15例(31.3%)、20例(41.7%)和11例(22.9%),差异有统计学意义(χ2=8.341、12.689、9.837,P均<0.05)。移植组治疗前及治疗后4、12、24、48周,ALT、Alb、TBil、PT和MELD评分,差异有统计学意义(F=6.172、9.795、10.961、11.198、19.652,P均=0.000);对照组治疗前及治疗后4、12、24、48周,ALT、Alb、TBil差异有统计学意义(F=5.594、13.664、12.612,P均=0.000),而PT和MELD评分,差异无统计学意义(F=1.698、2.652,P均>0.05)。移植组与对照组相比,治疗后第4周ALT、Alb、TBil、PT差异有统计学意义(t=3.394、11.625、8.847、15.781,P均<0.05),MELD差异无统计学意义(t=1.727,P>0.05);治疗后第48周,ALT、Alb、TBil、PT、MELD差异有统计学意义(t=5.477、8.830、6.371、11.362、9.426,P均<0.05)。随访至第48周,移植组与对照组病死率及肝癌发生率均差异无统计学意义(χ2=4.815、6.286,P均>0.05)。全部患者在移植术中,移植术后近期未发生严重并发症。结论经肝固有动脉自体BMSC移植治疗失代偿期肝硬化是一种安全、有效的方法,可作为肝移植治疗的过渡或补充治疗。
Objective To investigate the clinical therapeutic effect and safety of autologous bone marrow mesenchymal stem cells （BMSC） transplantation through proper hepatic artery in patients with decompensated liver cirrhosis. Methods Eighty-four patients with decompensated liver cirrhosis, which admitted in Department of Liver Diseases of the No. 533 Hospital of People＇s Liberation Army from 2012 Jun to 2013 Jun, were randomly divided into transplantation group （n = 36） and control group （n = 48）. Patients in control group received routine treatment, while patients in transplantation group received additional autologous BMSC transplantation through proper hepatic artery. Alanine aminotransferase （ALT）, albumin （Alb）, total bilirubin （TBil）, prothrombin time （PT） and model for end stage liver disease （MELD） were evaluated in both groups during follow-up at week 4, 12, 24 and 48, respectively. Comparison of liver function at different time after therapy between two groups carried out by independent t test , F test and LSD test. Incidence of hepatocellular carcinoma （HCC） and mortality were analyzed by Z2 test. Results Four weeks after treatment, there were 15 cases （41.7~） ascites subsiding, 21 cases （58.3%） abdominal distention disappearing and 13 cases （36. 1~~） edema of lower limbs relieving in transplantation group, while there were 15 cases （31.3%）, 20 cases （41.7G） and ll case （22.9%） in control group, respectively, which revealed statistically significant differences （P〈0.05）. In transplantation group at week4, 12, 24, 48, there were significant improvements in ALT, Alb, TBiL, PT and MELD （F = 6. 172, 9. 795, 10. 961 , 11. 198, 19. 652, P = 0. 000, respectively） than those at baseline. In control group, some parameters, including ALT, Alb and TBiL, had significant improvement （F=5. 594, 13. 664, 12. 612, P = 0. 000, respectively）, while other parameters, including PT and MELD, did not changed before and after therapy. At week 48, ALT, Alb, TBiL, PT and MELD showed significant differences between transplantation and control groups （t = 5. 477, 8. 830, 6. 371, 11. 362, 9. 426, P〈0.05, respectively）. No significant differences were observed in incidence of HCC and mortality （X2 = 4. 815,6. 286, P〈0. 05, respectively）. Additionally, no severe adverse effects oecured in patients during and after transplantation. Conelusion Autologous BMSC transplantation through proper hepatic artery for decompensated liver cirrhosis is a safe and effective therapy, which could be a bridging or a complementary treatment.
出处
《肝脏》
2016年第2期95-99,共5页
Chinese Hepatology
基金
云南省自然科学基金(2012FD095)
云南省教育厅科研基金重点项目(2014Z125)
关键词
肝硬化
骨髓间充质干细胞
移植
自体
肝动脉
治疗
Cirrhosis
Bone marrow mesenchymal stem cells
Transplantation
autologous
Hepatic artery
Treatment
