脐带间充质干细胞联合双重血浆分子吸附治疗慢加急性肝衰竭患者临床效果初步观察

doi:10.3969/j.issn.1672-5069.2020.04.023

摘要/Abstract

摘要： 目的探讨采用脐带间充质干细胞(UC-MSCs)联合双重血浆分子吸附系统(DPMAS)治疗慢加急性肝衰竭(ACLF)患者的临床效果。方法 2016年1月～2019年5月收治的ACLF患者45例,其中20例接受DPMA(对照组),另25例接受UC-MSCs移植联合DPMAS治疗(观察组),观察8周。使用BD公司FACScaliber流式细胞仪检测外周血CD3⁺T细胞、CD3⁺CD4⁺T细胞和CD3⁺CD8⁺T细胞百分比,采用ELISA法检测血清白细胞介素6(IL-6)、IL-10和肿瘤坏死因子α (TNF-α)水平。结果在治疗8周末,观察组血清胆红素水平为(43.3±14.5)μmol/L,终末期肝病模型评分为(16.8±4.1),显著低于对照组【分别为(56.6±10.5)μmol/L和(20.6±4.8),P＜0.05】,而血清白蛋白水平为(32.1±6.8)g/L,PTA为(57.9±5.3)%,显著高于对照组【分别为(27.2±7.3)g/L和(53.8±5.5)%,P＜0.05】;外周血CD3⁺CD8⁺T细胞百分比为(13.1±2.5)% ,显著低于对照组【(17.1±3.3)%,P＜0.05】,而CD3⁺T细胞为(63.1±3.1)%,显著高于对照组【(59.7±4.2)%,P＜0.05】,CD3⁺CD4⁺T细胞百分比为(39.1±4.3)%,显著高于对照组【(34.9±4.1)%,P＜0.05】;观察组血清TNF-α水平为(7.1±4.3)ng/L,显著低于对照组【(11.2±5.2)ng/L,P＜0.05】,血清IL-6水平为(8.4±2.7)ng/L,显著低于对照组【13.2±3.2)ng/L,P＜0.05】;对照组生存12例(60.0%)例,观察组生存22例(88.0%,P＜0.05)。结论在DPMAS治疗的基础上适时给予UC-MSC移植治疗ACLF患者近期疗效较好,其远期疗效还有待观察。

关键词: 慢加急性肝衰竭, 间充质干细胞, 脐带, 双重血浆分子吸附, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy of human umbilical cord-derived mesenchymal stem cell (UC-MSCs)transplantation at base of double plasma molecular absorption system (DPMAS) in the treamtment of patients with acute-on-chronic liver failure(ACLF). Methods 45 patients with ACLF were recruited in this study from January 2016 through May 2019, and 20 patients were treated with DPMAS for the control and 25 received UC-MSC transplantation at base of DPMAS. All patients were followed-up for eight weeks. Serum interleukin 6 (IL-6), IL-10 and tumor necrosis factor -α(TNF-α) were detected by ELISA, and peripheral blood lymphocyte subsets were tested by FCM. Results At the end of 8 week of treatment, serum bilirubin level in the cell transplanted group was (43.3±14.5)μmol/L and the model for end-stage liver disease score was (16.8±4.1), both significantly lower than 【(56.6±10.5)μmol/L and (20.6±4.8), respectively, P＜0.05】, while serum albumin level was (32.1±6.8)g/L, the PTA was (57.9±5.3)%, both significantly higher than 【(27.2±7.3)g/L and (53.8±5.5)%, P＜0.05】 in the control; the percentage of peripheral blood CD3⁺CD8⁺T cells was (13.1±2.5)%, much lower than 【(17.1±3.3)%, P＜0.05】, while that of CD3⁺T cells was (63.1±3.1)%, significantly higher than 【(59.7±4.2)%, P＜0.05】, and of CD3⁺CD4⁺T cells was (39.1±4.3)%, significantly higher than 【(34.9±4.1)%, P＜0.05】 in the control; serum TNF-α level was (7.1±4.3)ng/L, significantly lower than 【(11.2±5.2)ng/L, P＜0.05】 and serum IL-6 was (8.4±2.7)ng/L, much lower than 【13.2±3.2)ng/L, P＜0.05】 in the control; the survival rate in the control was 60.0%, much lower than 88.0% (P＜0.05) in cell transplanted group. Conclusion UC-MSC transplantation at base of DPMAS in the treatment of patients with ACLF has a good short-term efficacy, and its long-term impact on outcomes should be followed-up.

Key words: Acute-on-chronic liver failure, Umbilical cord-derived mesenchymal stem cells, Double plasma molecular absorption system, Efficacy

陈曦, 陈照林, 董静, 宋海燕, 刘波, 张骏飞, 陈从新. 脐带间充质干细胞联合双重血浆分子吸附治疗慢加急性肝衰竭患者临床效果初步观察[J]. 实用肝脏病杂志, 2020, 23(4): 544-547.

Chen Xi, Chen Zhaolin, Dong Jing, et al. Efficacy of human umbilical cord-derived mesenchymal stem cell transplantation at base of double plasma molecular absorption system in treamtment of patients with acute-on-chronic liver failure[J]. Journal of Practical Hepatology, 2020, 23(4): 544-547.

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