同源性骨髓細胞能改善冠狀動脈血流

治療頑固性冠狀動脈阻塞的新方法

  根據一項劃時代的研究結果顯示:對於特發性狹心絞痛頑固性冠狀動脈疾病患者,往心臟注入同源性骨髓細胞,可以改善其冠狀動脈血流,而其他治療措施都無效。

  日本Ube Yamaguchi 大學醫學院的講師,也是本研究的第一作者Kimikazu Hamano,在一次記者會上說到:「研究結果發現,這種治療方法很安全,我們相信,對於冠狀動脈繞道手術或氣球擴張術治療無效的心臟病患者,會另一種較好的選擇。」

  目前,有人正在對此進行一項臨床試驗研究,該研究始於1999年11月。5名患者接受往心臟缺血區域注入自體骨髓細胞的治療。受試者平均年齡為66歲,均患有嚴重的進行性心絞痛。根據患者心肌血容量的不同,對心肌注入骨髓細胞的次數為5次至22次不等,注射範圍直徑為1釐米。

  Hamano說到:「動物實驗研究所得結果很好,目前這項試驗的目的是證實在人類應用此種這種治療方法的安全性和有效性。」

  一個月後,對受試者進行螢光掃描術,結果顯示:這5名患者中,其中3人接受骨髓治療的患者心臟缺血區域的血流有明顯改善,嚴重的心絞痛得以舒緩。追蹤一年,進行胸部X光攝影、血液檢查、心電圖檢查和超音波檢查,結果顯示所有這些患者都沒有發生有害改變。目前第六位病患正進行此項治療。

  Hamano說到:「僅憑手術後血管造影片,很難證明這種治療方法能促進新血管的形成。」

  新血管形成的動物試驗研究結果顯示:在骨髓細胞注入後,實驗動物體內所生成的新生血管僅30-60微米,而血管造影術所能探測到的血管水平為200微米。

  Hamano說到:「因此,我們從血管造影片看不到新生血管是可以理解的。」

  對於缺血範圍過大的患者,採用傳統治療無效時,該技術尤其具有應用價值,因為成人自體骨髓幹細胞注入術治療安全、易行而且相對來說費用較為便宜。

Autologous Bone Marrow Cells Improve Coronary Blood Flow

New Therapeutic Option for Otherwise Untreatable Coronary Blockage

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Charlotte E. Grayson, MD

Nov. 26, 2001 -- A groundbreaking study shows promise that autologous bone marrow cells injected into the heart may improve coronary blood flow in people with irretractable angina and CAD not amenable to any other therapy. The first-of-its-kind study was presented recently at the American Heart Association's Scientific Sessions 2001 in Anaheim, CA.

"We found this new treatment to be safe, and we believe it could be an alternative treatment for heart patients who cannot be helped by coronary artery bypass surgery or balloon angioplasty," lead author Kimikazu Hamano, MD, a lecturer at the Yamaguchi University School of Medicine in Ube, Japan, said in a news release.

In an ongoing clinical trial beginning in November 1999, five patients received injections of their own bone marrow cells into ischemic regions of their hearts. Average age was 66, and all suffered severe and debilitating angina. Depending on the volume of heart muscle treated, the patients received between five and 22 injections of cells into the heart muscle, administered 1 centimeter apart.

"We have good results from these experiments in animal studies," Hamano says. "The aim of the current trial is to confirm the safety and efficacy of this treatment in humans."

In three of the five patients, cardiac scintigraphy one month after injection showed marked improvement in blood flow in ischemic regions treated with bone marrow, and severe angina disappeared. At one year follow-up, chest X-rays, blood tests, electrocardiography, and ultrasound studies did not reveal any detrimental changes in any patients. A sixth patient is currently being treated with this technique.

"It was difficult to clearly identify new vessels formed by this treatment on postoperative angiograms," Hamano said.

Animal studies of angiogenesis suggest that new vessels formed as the result of bone marrow cell injections are only 30 to 60 micrometers, whereas the detection level of blood vessels by angiography is more than 200 micrometers.

"Therefore, it is understandable that we could not see the new vessels," Hamano said.

This technique may be especially valuable in patients whose ischemia is too widespread to benefit from conventional treatment. Injecting adult stem cells from the patient's own bone marrow is easy, safe, and relatively inexpensive.


© 2001 WebMD Corporation. All rights reserved.

    
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