| Objective:The autologous peripheral blood stem cell transplantation in myocar dial infarction in the safety and clinical efficacy is still controversial. This issu e through clinical trials on the following issues in-depth discussion:1.Autologo us peripheral blood stem cell mobilization, collection and transplantation of sec urity issues.2. Coronary artery bypass surgery in the same period of autologou s peripheral blood stem cell transplantation for treatment of myocardial infarcti on in the near, medium-term clinical efficacy.3. Stem cell transplantation to th e ischemic myocardium after myocardial repair and regenerationMethods:Select January 2008-July 2009 admitted to our department for myocardial infarction patients, A total of 30 patients,21 males,9 females, The patients confirmed by coronary angiography coronary artery disease more support, has left anterior descending artery (LAD) lesions, ECG prompt performance with myocardial infarction, Cardiac ectopy tips have left ventricular wall mural movement weakened area, Heart ejection fraction significantly below normal, Radionuclide myocardial perfusion imaging in left ventricular inferior wall, posterior hypoperfusion, myocardial necrosis in the region confirmed the existence. Cases will be selected randomly divided into the control group and the transplant team, N=15 patients, the control group only coronary artery bypass grafting, were not stem cell transplantation; the transplant team, concomitant coronary artery bypass grafting with autologous peripheral blood stem cell transplantation. Transplant patients before surgery to recombinant human granulocyte colony stimulating factor (rhG-CSF) 400μg-600μg subcutaneously once a day, a total of five to seven days, the last of autologous peripheral blood collected in 90 minutes prior to use, aimed at mobilizing stem cells after mobilization, with the United States COBE Spectra blood cell separator for peripheral blood stem cell collection. In off-pump coronary artery bypass grafting (OPCABG), Complete the coronary artery anastomosed end-grafts, the acquisition of peripheral blood stem cell (APBSC) after grafts proximal and ischemic myocardium epicardial multi-point injection myocardial manner. Observation of patients in stem cell mobilization, acquisition and transfer process, record adverse reactions in patients with heart failure near, medium-term target of improving the situation, the developer of radionuclides originally filling defect area there are no new blood formation and extent.Results:Autologous peripheral blood stem cell mobilization, collection and transplantation process of the total 10 cases of adverse reactions, including APBSC mobilization process in the number of cases of adverse reactions accounted for 26.7% of the total number of transplant patients (4/15), APBSC adverse reactions collected during13.3%(2/15), APBSC Transplantation in adverse reactions accounted for 26.7%(4/15). After one month of cardiac ectopy display two groups of patients with left ventricular ejection fraction (LVEF), left ventricular diastolic volume (LVEDV) and other indicators of a respective preoperative improvement; After three months and six months echocardiography showed the index patients were significantly improved compared with preoperative, and between the two groups, transplantation group LVEF, LVEDD and other indicators of more than simple coronary artery bypass grafting group, significantly different (P<0.05); after 6 months, radionuclide imaging Tip:The patients of the original myocardial ischemia in the region have formed a new infusion, perfusion improved more significantly in the transplantation group, were significantly different (P＜0.05).Conclusion:Autologous peripheral blood stem cell mobilization, collection and transplantation is safe and feasible, than simply bypass surgery can significantly improve cardiac function in patients with better ischemic patients to be re-perfusion of myocardial infarction, myocardial repair and regeneration of cells obtained.
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