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The Study of Quality of Life after Autologous Bone Marrow Mononuclear Cells Transplantation in Patients with Heart Failure

Author: XingFei
Tutor: GaoChuanYu
School: Zhengzhou University
Course: Department of Cardiology
Keywords: Heart Failure Bone marrow mononuclear cells Quality of life
CLC: R541.6
Type: Master's thesis
Year: 2007
Downloads: 74
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Abstract

Background and Objective: Acute myocardial infarction (AMI) has become a threat to human life, \The morbidity and mortality of heart failure is still high. Due to the large area of ??myocardial cell necrosis after myocardial infarction is bound to cause myocardial contractility change diastolic stress increased invalid acting, and thus cardiac remodeling and heart failure. The most common clinical complication is heart failure after myocardial infarction. Dilated cardiomyopathy is the most common clinical primary cardiomyopathy, its incidence motives myopathy first major clinical manifestations of heart enlargement, heart murmur, arrhythmia, congestive heart failure, the ultimate expression of malignant arrhythmia and sudden cardiac death. The heart transplant is still the best method for the treatment of advanced refractory heart failure, but its application is limited due to immune rejection reaction immunosuppressive effects, the reason of the lack of donors and donor recipient matching difficulties. How as much as possible to reduce myocardial necrosis, as much as possible to save viable myocardium cells as much as possible to increase the number of effective working myocardial cells, can effectively reduce the high mortality rate due to heart failure after myocardial infarction, increased myocardial infarction quality of life and long-term survival. In recent years, the rise of the cell therapy (Cell Therapy) can replace, repair or enhance the biological function of damaged tissues or organs, and so has become a new strategy for the treatment of a variety of diseases. Bone marrow stem cell transplantation is a cell therapy, many studies have shown that stem cell self-renewal and differentiation capacity, able to cross-system, cross-endoderm differentiation and development for a variety of tissue cells. Animal studies and Phase I clinical trials on the efficacy, safety, and its potential for clinical application of adult stem cell transplantation has been exciting research. The quality of life is a broad concept, including physiological extent as a reflection of human physical function, mental status and social indicators of the ability to adapt, is able to reflect the level of health of the human body. However, autologous bone marrow mononuclear cells transplantation for more than six months of life quality follow-up and control research, has not been reported. This study as an entry point, the use of self-control and group control designed in our previous study, there certainly have come to \efficacy \and control. We talk by telephone follow-up and the opposite way, random application of the SF-36 questionnaire scale quality of life survey ratings, and preliminary analysis of deaths, combined with the United States New York Heart Association functional class (NYHA) and six-minute walk distance test ( 6MWT), comprehensive evaluation of autologous bone marrow mononuclear cell transplantation for heart failure patients with clinical efficacy and impact on quality of life. Subjects and methods: the first case of autologous bone marrow mononuclear cells in the treatment of acute large anterior myocardial infarction complicated by heart failure, our hospital since July 26, 2003 to December 2006, we completed a total of more than 300 patients (less Some patients were twice or three times a transplant). By telephone follow-up and face-to-face interviews, random survey of 87 cases treated patients and 79 control patients, they are in line with the requirements of the experimental design. The treatment group included 34 patients with dilated cardiomyopathy disease (DCM), 33 patients with old myocardial infarction (OMI), 20 patients with acute myocardial infarction (AMI); control group included 30 patients with dilated cardiomyopathy disease (DCM), 27 patients with old myocardial infarction (OMI), 22 patients with acute myocardial infarction (AMI). All patients with LVEF <45%. The treatment of selected patients with preoperative laboratory through bilateral iliac spine 6:00 Law bone marrow by Ficoll density gradient centrifugation of lymphocytes separated liquid bone marrow mononuclear cell suspensions by flow cytometry on BM-MNCs obtained cell count and ingredients identified through large lumen catheters or catheter surgery, respectively, at around intracoronary injection of autologous bone marrow mononuclear cells, the application of the SF-36 questionnaire scales for all patients for at least six months after surgery quality of life follow-up as well as the control group, a preliminary analysis of the patients died. Patients treated with preoperative and postoperative six months, a year NYHA class and six-minute walking distance and self-control. Independent samples t-test measurement data spss13.0 software; count data x ~ 2 test, P <0.05 as statistically significant difference (α = 0.05). Results: 1 treatment group mortality was 10.3% in patients: patients in the control group mortality rate was 11.4%. X ~ 2 test, the two groups of patients, the mortality found no statistically significant difference. 2 patients treated with an effective rate of 77.0%; effective rate was 62.0% in the control group patients. X ~ 2 test, the two groups of patients, the treatment efficiency there is a statistically significant difference (P <0.05). The three aspects of dilated cardiomyopathy treatment group, the overall state of health (GH), physical function, role limitations (RP) and mental health (MH) scores were 63.0 ± 21.5,26.7 ± 14.2,83.1 ± 15.2, while the control group were 47.9 ± 24.8,15.6 ± 10.4,69.7 ± 20.6, there is a statistically significant difference (P <0.05). Old myocardial infarction group physical function, role limited (RP), body pain (BP) 2 scores were 43.8 ± 29.7,84.6 ± 21.6, while the control group were 14.9 ± 13.2,67.0 ± 25.2 there is a significant difference (P <0.05). 5 acute myocardial infarction treatment group, the overall state of health (GH), social function (SF), limited physical function, role (RP) vitality (VT) 4 scores were 76.9 ± 23.4,86.5 ± 22.8,59.7 ± 38.5 , 78.8 ± 16.5, while the control group were 47.5 ± 24.4,68.2 ± 24.9,27.6 ± 17.4,56.7 ± 18.9, there are significant difference. The overall ratings of the quality of life in the treatment group was 81.8 ± 18.5, while the control group was 66.2 ± 15.6, both also there is a statistically significant difference (P <0.05). Follow-up results of the 6 NYHA cardiac function classification: acute myocardial infarction, old myocardial infarction, dilated cardiomyopathy in NYHA functional classification preoperative were 2.03 ± 0.38,2.57 ± 0.42,2.65 ± 0.51 Ji; after six months were 1.94 ± 0.31,2.05 ± 0.38,2.11 ± 0.57 level; postoperative year were 1.90 ± 0.30,2.02 ± 0.38,2.09 ± 0.45 Ji. Preoperative cardiac function grading of the three groups of patients with acute myocardial infarction group was significantly lower than the old myocardial infarction group with dilated cardiomyopathy group, and old myocardial infarction and dilated cardiomyopathy group had no significant difference. After six months that showed old myocardial infarction, dilated cardiomyopathy group compared with preoperative heart function significantly improved, compared to acute myocardial infarction with preoperative did not show a statistically significant difference (P> 0.05); shows a statistically significant difference (P <0.05). All further improvement in cardiac function in patients one year after surgery, but after six no further showed a statistically significant difference (P> 0.05). Control study group, we found that six months after the stem cell transplant, and old myocardial infarction and dilated cardiomyopathy group NYHA class significantly reduced heart function improved significantly (P <0.05), and in stem cell transplantation still a slight improvement. Acute myocardial infarction group NYHA class year after surgery compared to after six months, although no significant statistical difference, but also to some extent reduce. 7 six minutes walk from the follow-up results: the 6-minute walking distance of the group of patients with acute myocardial infarction, old myocardial infarction, dilated cardiomyopathy (6MWT) in the preoperative were 315.6 ± 47.1,265.8 ± 45.6,247.2 ± 41.0; surgery the second half of the year were 353.5 ± 49.6,348.9 ± 50.1,339.4 ± 48.7; after year to 364.7 ± 52.5,360.2 ± 50.2,355.9 ± 43.9, respectively. 6-minute walking distance (6MWT) in three groups of patients with preoperative acute myocardial infarction group was significantly better than the old myocardial infarction and dilated cardiomyopathy group, old myocardial infarction, dilated cardiomyopathy was no significant difference. After six months that shows the 6-minute walking distance of the three groups of patients were significantly increased acute myocardial infarction group compared with before surgery did not show a statistically significant difference (P> 0.05); old myocardial infarction group with dilated cardiomyopathy disease group compared with preoperative shows a statistically significant difference (P <0.05). Year after surgery, 6 minutes walking distance of all patients were further increased, but after six shows a statistically significant difference (P> 0.05) were not. Group control study, we found that six months after the stem cell transplant, and old myocardial infarction and dilated cardiomyopathy group 6-minute walk distance increased significantly (P <0.05), and in the year after stem cell transplantation is still slightly higher. Year after surgery with acute myocardial infarction, 6-minute walk distance compared with after six months, although no statistically significant differences, but also to some extent improved. Conclusions: Autologous bone marrow mononuclear cells (BM-MNCs) the intracoronary transplantation can significantly improve the quality of life in patients with acute myocardial infarction. 2 autologous bone marrow mononuclear cells (BM-MNCs) intracoronary transplantation also have a certain effect on the improvement of the quality of life of old myocardial infarction dilated cardiomyopathy and reperfusion by PCI was successful. 3 autologous bone marrow mononuclear cell transplantation after six months, with old myocardial infarction and dilated cardiomyopathy patients with NYHA class was significantly reduced heart function improved significantly (P <0.05), and in stem cell transplantation is still slightly higher. Acute myocardial infarction, NYHA class reduced to some extent. 4 autologous bone marrow mononuclear cell transplantation after six months old myocardial infarction patients with dilated cardiomyopathy by 6-minute walk distance increased significantly (P <0.05), and in stem cell transplantation is still a slight improvement. 6 minutes walking distance of the acute myocardial infarction group also increased to some extent. 5 autologous bone marrow mononuclear cells intracoronary transplantation can reduce the mortality rate of patients with heart failure, an increase in the incidence of malignant tumors, still remains to be the long-term follow-up of a large sample, and further research.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Blood circulation failure
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