Cui L N, Wang X F, Sun R Q, Deng J, Gao Z J, Zhou X M, Guo C C, Jia G, Shang Y L, Yang C M, Han Y
Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an 710032, China.
Zhonghua Gan Zang Bing Za Zhi. 2022 Mar 20;30(3):279-284. doi: 10.3760/cma.j.cn501113-20220228-00091.
Autologous peripheral blood stem cells (PBSC) derived from bone marrow can promote liver regeneration and improve the liver function of patients, but there are few studies on its effect on the long-term outcomes in patients with decompensated cirrhosis. Based on previous work, this study observed the clinical outcomes of PBSC treatment in patients with decompensated cirrhosis for 10 years, in order to provide more data support for the safety and efficacy of stem cells in clinical applications. Data of patients with decompensated liver cirrhosis who completed PBSC treatment in the Department of Gastroenterology of the First Affiliated Hospital of Air Force Military Medical University from August 2005 to February 2012 were included. The follow-up endpoint was death or liver transplantation, and patients who did not reach the follow-up endpoint were followed-up for at least 10 years. The patients with decompensated liver cirrhosis who met the conditions for PBSC treatment but did not receive PBSC treatment in our hospital during the same period were used as controls. A total of 287 cases with decompensated liver cirrhosis had completed PBSC treatment, and 90 cases were lost to follow-up within 10 years after surgery. A total of 151 cases with complete survival follow-up data were included in the control group. There were no statistically significant differences in baseline information such as gender, age, etiological composition and liver function score between the two groups. The 10-year survival rate was higher in PBSC than control group (37.56% vs. 26.49%, <0.05). Cholinesterase, albumin, international normalized ratio, Child-Turcotte-Pugh score, model for end-stage liver disease score, and other indicators were gradually recovered within 3 months to 1 year after PBSC treatment, and stabilized at a more desirable level in the long-term after follow-up for up to 10 years. There was no statistically significant difference in the incidence of liver cancer between the two groups (25.22% vs.31.85%, =0.267). The age of onset of hepatocellular carcinoma was later in PBSC than control group [(56.66±7.21) years vs. (52.69±8.42) years, <0.05]. This long-term observational follow-up study of more than ten years confirms that PBSC treatment can bring long-term benefits to patients with decompensated cirrhosis, with good long-term safety, thus providing more data support on the safety and efficacy of stem cells for clinical applications.
源自骨髓的自体外周血干细胞(PBSC)可促进肝脏再生并改善患者肝功能,但关于其对失代偿期肝硬化患者长期预后影响的研究较少。基于先前的工作,本研究观察了失代偿期肝硬化患者接受PBSC治疗10年的临床结局,以便为干细胞临床应用的安全性和有效性提供更多数据支持。纳入2005年8月至2012年2月在空军军医大学第一附属医院消化内科完成PBSC治疗的失代偿期肝硬化患者的数据。随访终点为死亡或肝移植,未达到随访终点的患者至少随访10年。将同期在我院符合PBSC治疗条件但未接受PBSC治疗的失代偿期肝硬化患者作为对照。共有287例失代偿期肝硬化患者完成了PBSC治疗,90例在术后10年内失访。对照组共纳入151例有完整生存随访数据的患者。两组在性别、年龄、病因构成和肝功能评分等基线信息方面无统计学显著差异。PBSC组的10年生存率高于对照组(37.56%对26.49%,<0.05)。PBSC治疗后3个月至1年内,胆碱酯酶、白蛋白、国际标准化比值、Child-Turcotte-Pugh评分、终末期肝病模型评分等指标逐渐恢复,并在长达10年的随访中长期稳定在更理想水平。两组肝癌发生率无统计学显著差异(25.22%对31.85%,=0.267)。PBSC组肝细胞癌发病年龄晚于对照组[(56.66±7.21)岁对(52.69±8.42)岁,<0.05]。这项长达十多年的长期观察性随访研究证实,PBSC治疗可为失代偿期肝硬化患者带来长期益处,长期安全性良好,从而为干细胞临床应用的安全性和有效性提供更多数据支持。