Srimahachota Suphot, Boonyaratavej Smonporn, Rerkpattanapipat Pairoj, Wangsupachart Somjai, Tumkosit Monravee, Bunworasate Udomsak, Nakorn Thayapong Na, Intragumtornchai Tanin, Kupatawinturn Pawinee, Pongam Sunisa, Saengsiri Aem-orn, Pothisri Mantana, Sukseri Yeesoon, Bunprasert Tanorm, Suithichaiyakul Taworn
Division of Cardiovascular Diseases, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
J Med Assoc Thai. 2009 Dec;92(12):1591-6.
Stem cell transplantation is a potential treatment to improve left ventricular ejection fraction (LVEF) after ST elevation myocardial infarction (STEMI). However technique and mode of transplantation, type of cells, number of cells, and when to transplant are still unknown.
To determine the feasibility and safety of bone marrow mononuclear cell (BMC) intra-coronary transplantation and 6-months results in patients with STEMI.
After successful percutaneous coronary intervention (PCI) in STEMI patients who did not have flow re-established within 12 hours and poor LVEF (less than 50%) by echocardiography were enrolled Bone marrow aspiration of 100 cc was performed in the morning. After cell processing for 3 hours, the suspension of BMC about 10 cc were infused to infarcted area using standard PCI technique. Balloon occlusion for 3 minutes was performed during cell infusion. Cardiac magnetic resonance imaging was used to determine LVEF scar volume and LV volume before and 6 months after transplantation.
Five patients were enrolled between May and August 2006. Duration of STEMI before transplantation ranged from 18 days to 14 years. Total amount of BMC ranged from 67 x 10(6) to 335 x 10(6). Number of CD 34 and CD 133+ cells were approximation to be 0.7 x 10(6) to 7.7 x 10(6) and 0.01 x 10(6) to 3.04 x 10(6). LVEF was increased from 36.4 at baseline to 43.3 at 6-month. NT pro-BNP level was decreased from 1105 ng/ml at baseline to 288 pg/ml at 6-month. No complications such as chest pain, no re-flow phenomenon, ventricular arrhythmia, or hypotension was detected during the procedure.
Intra-coronary BMC transplantation in patients with STEMI in our center is feasible and safe. LVEF was slightly improved; however, a randomized controlled study is needed.
干细胞移植是改善ST段抬高型心肌梗死（STEMI）后左心室射血分数（LVEF）的一种潜在治疗方法。然而，移植技术和方式、细胞类型、细胞数量以及移植时机仍不清楚。
确定冠状动脉内移植骨髓单个核细胞（BMC）的可行性和安全性以及STEMI患者6个月的结果。
入选在STEMI患者中，经皮冠状动脉介入治疗（PCI）成功但在12小时内未恢复血流且经超声心动图检查左心室射血分数低（低于50%）的患者。于上午进行100cc骨髓穿刺。细胞处理3小时后，使用标准PCI技术将约10cc的BMC悬浮液注入梗死区域。在细胞注入过程中进行3分钟的球囊闭塞。移植前和移植后6个月使用心脏磁共振成像来确定LVEF、瘢痕体积和左心室体积。
2006年5月至8月纳入5例患者。移植前STEMI持续时间为18天至14年。BMC总量为67×10⁶至335×10⁶。CD34和CD133⁺细胞数量分别约为0.7×10⁶至7.7×10⁶和0.01×10⁶至3.04×10⁶。LVEF从基线时的36.4提高到6个月时的43.3。NT-proBNP水平从基线时的1105ng/ml降至6个月时的288pg/ml。在该过程中未检测到胸痛、无复流现象、室性心律失常或低血压等并发症。
本中心对STEMI患者进行冠状动脉内BMC移植是可行且安全的。LVEF略有改善；然而，需要进行随机对照研究。
