论文部分内容阅读
目的观察自体骨髓间充质干细胞(BMSC)移植治疗肝硬化难治性腹水的疗效及安全性。方法对2010年9月至2013年9月入住南京总医院消化内科经正规利尿、补充白蛋白达3个月以上且疗效欠佳的32例肝硬化腹水患者,在原有治疗基础上加用自体BMSC移植治疗,分别于治疗前、治疗后1个月及3个月观察腹围、体重、24 h尿量、血清尿素氮、肌酐、尿钠及血清蛋白浓度等指标变化。采用方差分析、配对t检验和Wilcoxon检验进行统计学分析。结果治疗前,患者体重、腹围、24 h尿量及血清尿素氮、肌酐、血清总蛋白、血清白蛋白及尿钠排出水平分别为(66.9±3.8)kg、(94.0±3.6)cm、(966±138.7)ml、(10.5±3.6)mmol/L、(112.4±30.6)μmol/L、(63.8±4.2)g/L、(32.1±2.7)g/L、(43.8±2.3)mmol/L;治疗后1个月,分别为(66.0±3.9)kg、(93.0±3.6)cm、(1032±154.8)ml、(9.9±3.2)mmol/L、(104.8±25.6)μmol/L、(65.3±3.5)g/L、(32.6±2.9)g/L、(44.7±2.7)mmol/L;治疗后3个月,分别为(56.2±3.7)kg、(80.5±4.5)cm、(1530±180.6)ml、(7.9±2.3)mmol/L、(88.7±22.2)μmol/L、(72.8±3.3)g/L、(39.2±1.5)g/L。3个组别8个指标均数比较有统计学意义(F=78.194、117.689、120.527、6.558、6.712、54.827、83.421、493.776,均P=0.000)。治疗后1个月与治疗前水平差异无统计学意义(t分别为0.587、0.636、0.559、0.556、0.678、0.522、0.611、0.592;P=0.331、0.266、0.101、0.416、0.25、0.107、0.447);而治疗后3个月,患者的体重、腹围较治疗前及治疗后1个月均明显减少,24 h尿量明显增加(与治疗前比较,t=3.722、3.784、3.821,与治疗后1个月比较,t=3.921、3.834、3.944,均P=0.000),血清尿素氮、肌酐水平较治疗前及治疗后1个月均明显下降;而血清总蛋白、白蛋白及尿钠排出水平均明显升高(与治疗前比较,t=2.182、2.338、2.182、2.412、2.136,P尿素、肌酐=0.001,其余P=0.000;与治疗后1个月比较,t=2.392、2.283、2.194、2.331、2.442,均P=0.000),治疗后1个月总有效率为18.75﹪,3个月后治疗总有效率达100﹪,疗效差异有统计学意义(Z=-5.014,P=0.000),无严重并发症发生。结论自体BMSC移植术治疗肝硬化难治性腹水安全有效,且方法简便易行。
Objective To observe the efficacy and safety of autologous bone marrow mesenchymal stem cells (BMSCs) transplantation in the treatment of refractory ascites due to cirrhosis. Methods From September 2010 to September 2013 admitted to Nanjing General Hospital, Department of Gastroenterology, formal diuresis, albumin for more than 3 months and poor efficacy of 32 patients with cirrhosis and ascites, on the basis of the original treatment with autologous BMSC The changes of abdominal circumference, body weight, 24 h urine volume, serum urea nitrogen, creatinine, urine sodium and serum protein concentration were observed before treatment, 1 month and 3 months after treatment. ANOVA, paired t-test and Wilcoxon test were used for statistical analysis. Results Before treatment, the patients’ body weight, abdominal circumference, 24-hour urine output and serum urea nitrogen, creatinine, serum total protein, serum albumin and urinary sodium excretion were (66.9 ± 3.8) kg and (63.1 ± 2.7) g / L, (43.8 ± 2.3) mmol / L, , Respectively; (66.0 ± 3.9) kg, (93.0 ± 3.6) cm, (1032 ± 154.8) ml, (9.9 ± 3.2) mmol / L, (104.8 ± 25.6) μmol / L, ± (3.5 ± 2.5) g / L, (32.6 ± 2.9) g / L and (44.7 ± 2.7) mmol / L, respectively; 180.6) ml, (7.9 ± 2.3) mmol / L, (88.7 ± 22.2) μmol / L, (72.8 ± 3.3) g / L and (39.2 ± 1.5) g / L respectively. Three groups of eight indicators were statistically significant (F = 78.194,117.689,120.527,6.558,6.712,54.827,83.421,493.776, all P = 0.000). There was no significant difference between pretreatment and 1 month after treatment (t = 0.587,0.636,0.559,0.556,0.678,0.522,0.611,0.592, respectively; P = 0.331,0.266,0.101,0.416,0.25,0.107,0.447) ; 3 months after treatment, the patient’s weight and abdominal circumference were significantly lower than before treatment and 1 month after treatment, 24 h urine output increased significantly (compared with before treatment, t = 3.722,3.784,3.821, and after treatment 1 month, t = 3.921,3.834,3.944, both P = 0.000), serum urea nitrogen, creatinine levels were significantly lower than before treatment and 1 month after treatment; and serum total protein, albumin and urine sodium levels Were significantly higher than those before treatment (t = 2.182,2.338,2.182,2.412,2.136, P urea, creatinine = 0.001, the remaining P = 0.000; t = 2.392,2.283,2.194, 2.331,2.442, P = 0.000). The total effective rate was 18.75% at 1 month after treatment and 100% at 3 months after treatment. The difference was statistically significant (Z = -5.014, P = 0.000) No serious complications occurred. Conclusion Autologous BMSC transplantation is safe and effective in the treatment of refractory ascites due to liver cirrhosis. The method is simple and easy to operate.