自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者疗效初步研究

doi:10.3969/j.issn.1672-5069.2019.01.022

摘要/Abstract

摘要： 目的探讨血浆透析滤过联合自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者的疗效。方法入组120例慢加急性乙型肝炎肝衰竭早中期患者,均接受内科综合治疗和血浆透析滤过（PDF）治疗,其中58例接受PDF联合自体骨髓干细胞移植治疗,观察患者症状、体征、生存率、活动状态评分（ECOG）、终末期肝病模型（MELD）评分、CTP分级和肝功能的变化。结果在治疗24 w和48 w,干细胞移植组患者生存率分别为70.7%和55.2%,显著高于血浆透析滤过组的51.6%和32.2%（P<0.05）,干细胞移植组患者ECOG评分≥2级者分别为27.5%和12.5%,显著低于血浆透析滤过组的56.3%和40.0%（P<0.05）;在治疗24 w,干细胞移植患者MELD评分和吲哚菁绿15分钟存留率（ICGR15）分别为（18.6±4.1）和（20.6±8.1）%,显著低于血浆透析滤过患者【分别为（20.4±5.2）和（28.7±10.3）%,P<0.05】;58例行自体骨髓干细胞移植治疗患者术中未出现严重不良反应。结论自体骨髓干细胞移植治疗经血浆透析滤过术后的早中期患者可明显提高患者生存率,并且有良好的安全性。

关键词: 慢加急性肝衰竭, 骨髓干细胞移植, 血浆透析滤过, 疗效

Abstract: Objective To investigate the efficacy of autologous bone marrow stem cell transplantation for treatment of patients with hepatitis B-induced acute-on-chronic liver failure（ACLF）. Methods 120 patients with hepatitis B-induced ACLF at early and middle stages were recruited in this study,all of them received plasma diafiltration（PDF） at the base of conventional supporting measures,and 58 cases out of them received autologous bone marrow stem cell transplantation via hepatic artery. The survival rates,activity status,MELD score,CTP grade,liver functions,clinical symptoms and adverse reactions were compared between the two groups. Results At the end of 24 w and 48 w after transplantation,the survival rates in patients with stem cell transplantation were 70.7%and 55.2%,respectively,much higher than 51.6% and 32.2% （P<0.05） in those without;the percentages of Eastern Cooperative Oncology Group（ECOG） score ≥2 were 27.5% and 12.5%,respectively,much lower than 56.3% and 40.0% （P<0.05）;at the end of 24 w,the MELD score and indocyanine green retention rate at 15 min （ICGR15） were （18.6±4.1） and （20.6±8.1）%,much lower than （20.4±5.2） and （28.7±10.3）% （P<0.05）;no severe untoward effect was found in patients underwent stem cell transplantation. Conclusion Autologous bone marrow stem cell transplantation at the base of artificial liver support is effective in the treatment of patients with ACLF at early and middle stage,which warrants further validation.

Key words: Acute-on-chronic liver failure, Autologous bone marrow stem cells, Plasma diafiltration, Efficacy

闫焕杰, 张淑芹, 赵文静. 自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者疗效初步研究[J]. 实用肝脏病杂志, 2019, 22(1): 81-84.

Yan Huanjie, Zhang Shuqin, Zhao Wenjing.. Therapeutic efficacy of autologous bone marrow stem cell transplantation for treatment of patients with hepatitis B-induced acute-on-chronic liver failure[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(1): 81-84.

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