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中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (03) : 232 -238. doi: 10.3877/cma.j.issn.2095-3232.2020.03.008

所属专题: 文献

临床研究

间充质干细胞治疗肝移植术后难治性急性呼吸窘迫综合征
郭俊1, 易小猛1, 安玉玲1, 魏绪霞1, 范明明1, 黎利娟1, 陆平兰1, 易慧敏1, 吕海金1,()   
  1. 1. 510630 广州,中山大学附属第三医院外科ICU
  • 收稿日期:2020-02-26 出版日期:2020-06-10
  • 通信作者: 吕海金
  • 基金资助:
    临床研究专项基金远航计划(QHJH201804); 广东省自然科学基金(2018A0303130305); 广东省重点领域研发计划项目(2019B020236003)

Mesenchymal stem cells for refractory acute respiratory distress syndrome after liver transplantation

Jun Guo1, Xiaomeng Yi1, Yuling An1, Xuxia Wei1, Mingming Fan1, Lijuan Li1, Pinglan Lu1, Huimin Yi1, Haijin Lyu1,()   

  1. 1. Surgical ICU, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2020-02-26 Published:2020-06-10
  • Corresponding author: Haijin Lyu
  • About author:
    Corresponding author: Lyu Haijin, Email:
引用本文:

郭俊, 易小猛, 安玉玲, 魏绪霞, 范明明, 黎利娟, 陆平兰, 易慧敏, 吕海金. 间充质干细胞治疗肝移植术后难治性急性呼吸窘迫综合征[J]. 中华肝脏外科手术学电子杂志, 2020, 09(03): 232-238.

Jun Guo, Xiaomeng Yi, Yuling An, Xuxia Wei, Mingming Fan, Lijuan Li, Pinglan Lu, Huimin Yi, Haijin Lyu. Mesenchymal stem cells for refractory acute respiratory distress syndrome after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(03): 232-238.

目的

探讨人脐带间充质干细胞(HUMSCs)治疗肝移植术后难治性急性呼吸窘迫综合征(ARDS)安全性及疗效。

方法

回顾性分析2015年12月3日至2018年12月20日在中山大学附属第三医院接受HUMSCs挽救性治疗的10例难治性中重度ARDS肝移植患者临床资料。患者或其家属均签署知情同意书,符合医学伦理学规定。其中男8例,女2例;年龄23~69岁,中位年龄48岁。观察HUMSCs治疗安全性,并比较HUMSCs治疗前后氧合指数、肺损伤评分、肺水肿影像学评分(RALE)改变。治疗后参数变化分析采用单因素重复测量方差分析和Bonferroni法检验。

结果

HUMSCs输注过程中未观察到与输注相关的不良事件。与HUMSCs输注前平均氧合指数(109±29)mmHg(1 mmHg=0.133 kPa)比较,输注后1 d氧合指数(235±132)mmHg明显升高(t=3.00,P<0.017);与输注前肺损伤评分(2.9±0.6)分比较,输注后3 d肺损伤评分(1.8±0.9)分明显降低(t=-4.00,P<0.017);与输注前RALE评分(33±5)分比较,输注后7 d的RALE评分(27±7)分明显降低(t=-4.40,P<0.017)。6例难治性中度ARDS肝移植患者,其中4例均在1周内氧合好转后顺利脱机拔管。另2例中度及4例重度难治性ARDS患者死于原发病进展。

结论

HUMSCs治疗肝移植术后难治性ARDS患者安全可行,对肺损伤有显著改善。

Objective

To evaluate the safety and efficacy of human umbilical mesenchymal stem cells (HUMSCs) in the treatment of refractory acute respiratory distress syndrome (ARDS) after liver transplantation.

Methods

Clinical data of 10 patients with refractory moderate to severe ARDS undergoing salvage HUMSCs therapy in the Third Affiliated Hospital of Sun Yat-senUniversity from December 3, 2015 to December 20, 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 8 patients were male and 2 female, aged 23-69 years with a median age of 48 years. The safety of HUMSCs treatment was observed. The changes of oxygenation index, lung injury score and radiological assessment of lung edema (RALE) before and after HUMSCs treatment were statistically compared. After HUMSCs treatment, the parameter changes were analyzed by single-factor repeated measurement analysis of variance and Bonferroni method.

Results

No adverse events related to HUMSCs infusion were observed. Compared with the average oxygenation index of (109±29) mmHg (1 mmHg=0.133 kPa) before HUMSCs infusion, the oxygenation index at 1 d after HUMSCs infusion was significantly elevated to (235±132) mmHg (t=3.00, P<0.017). Compared with the lung injury score of 2.9±0.6 before HUMSCs infusion, the lung injury score was significantly declined to 1.8±0.9 at 3 d after HUMSCs infusion (t=-4.00, P<0.017). Compared with the RALE score of 33±5 before infusion, the RALE score was significantly decreased to 27±7 at 7 d after infusion (t=-4.40, P<0.017). 6 patients with refractory moderate ARDS underwent liver transplantation, and 4 of them were successfully extubated after oxygenation index was improved within 1 week. The remaining 2 patients with moderate ARDS and4 patients with severe refractory ARDS died of primary disease progression.

Conclusions

HUMSCs infusion is a feasible and safe treatment for refractory ARDS after liver transplantation, which can significantly mitigate the lung injury.

图1 十例难治性中重度ARDS肝移植患者HUMSCs输注后呼吸及血流动力学参数监测
图2 十例难治性中重度ARDS肝移植患者HUMSCs输注后肾功能变化
图3 十例难治性中重度ARDS肝移植患者输注HUMSCs肺损伤改善情况
图4 十例难治性中重度ARDS肝移植患者输注HUMSCs血清炎症指标变化
图5 十例难治性中重度ARDS肝移植患者输注HUMSCs肺泡灌洗液炎症指标变化
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