| Backgrounds and ObjectivesHepatic cirrhosis is a common clinical disease, especially type B hepatitis cirrhosis and alcoholic cirrhosis, Liver function will turn from bad to worse after ingression of decompensation, and most patients end with liver function failure.Orthotopic liver transplantation is the ideal approach to cure terminal stage hepatic cirrhosis, but the lack of donors, high cost of the operations, as well as long-term use of immunodepressant limit its development. Now, research of stem cell have got remarkable achievements in the medical field, which also provides a new method for the treatment of terminal stage hepatic cirrhosis.15 patients of decompensation hepatic cirrhosis have undertaken autologous bone marrow stem cell transplantion in this experiment. In asepsis conditions, patients received toponarcosis and sterilization, and bone marrow stem cell suspension was injected into liver through arteriae femoralis intubation to arteria hepatica propria under X-ray perspective. According to the results of observesion,2 or 4 weeks after transplantation, ALT became lower, TBIL also went down, ALB gradually increased, PT and PA advanced by several degrees, cholinphospholipid enzyme activity advanced, and cholesterol advanced. It indicated that the patients'liver function improved obviously after the bone marrow stem cell transplantation. It also indicated that the majority of the patients had clinical symptoms apparently improved after the autologous bone marrow stem cell transplantion. No serious adverse effect and complications were detected among the 15 patients. In the group of liver dysfunctional patients who have adopted autologous bone marrow stem cell transplantation through arteria hepatica propria, we got curative effects.Materials and methods1. Sample origins 15 patients of decompensation cirrhosis admitted in our hosipital during November 2007 and September 2009,12 men and 3 women, were studied. The age ranged from 26 to 53, and the average age is 42.10 patients are chronic type B hepatitis cirrhosis, and 5 alcoholic cirrhosis. According to the criteria for Child-Pugh Classification,2 patients are classified to grade A,5 are grade B,and 8 are grade C. Preoperative B ultrasonic inspection in abdomen and CT examination were taken in all patients. The laboratory examination included:glutamic-pyruvic transaminase(ALT), glutamic-oxaloacetic transaminase(AST), total bilirubin (TBIL),albumin (ALB), thrombinogen time (PT) and thrombinogen activity (PA). All patients were given corresponding internal medicine treatment.2. Approaches:Draw autologous bone marrow 200ml from each patient in the operation day, and separate marrow mononuclear cells through density gradient centrifugation. Marrow stem cell extracting form each patient should not be less than 2×108 in total, and would be placed in 20ml isotonic sodium chloride and preseved in asepsis bottle under 37℃constant temperature.The marrow mononuclearcell transplantation should be taken in 4 hours. Through femoral artery puncture, selectivity arteria hepatica propria arteriography would be done at the first step, and then marrow mononuclear cells which have been diluted in 50ml isotonic sodium chloride should be injected slowly into the liver through catheter.3. Curative effects:Clinical symptoms and physical signs were observed after the operation, liver function, PT,PA and B ultrasonic, CT are rechecked inl week,2 weeks,1 month,2 month,6month and 1 year after the operation. According to clinical symptoms, physical signs and the result of laboratory examination, patients could be divided into three groups:effective (no less than 2 clinical symptoms or physical signs improving, and no less than 2 results of laboratory examination index improving),invalid (no more than 1 clinical symptom and physical sign improving, and no more than 1 laboratory examination index improving), deteriorating(clinical symptom and physical sign deteriorating and laboratory examination index keeping innormal).4. Statistical treatment:The data were analyzed with t-test and Pearson correlation by SPSS 10.0, size of significance test a=0.05.Results1. As is showed in hepatic arteriography,all liver volume has shrinked and hepatica arteria indicate curly-hair appearence which is typical in liver cirrhosis.Preoperative CT and B ultrasonic inspection found no tumor. All patient's AFP are negative.2 patients of posthepatitic cirrhosis decompensation stage, Intubation through arteriae femoralis arteria, hepatic arteriography indicate that arteria hepatica branch is common, meatus place in arteria hepatica to pour into stem cell suspension (picture 1,2).2. The results of liver function correlation index detected in different time after the bone marrow stem cell intervention are listed in chart 1 and chart 2.3. Accroding to the data got in 2 months after the operation,13 cases are in effect,2 cases invalid, no case get worse. Among the 8 cases who are in effect in1 year after the operation,3 patients who had significant improvement are all alcoholic patients.Consequences of Liver function correlated index of these three patients detected before and after the transplantion are showed in chart3 and chart 4.4. All cases have no fever, allergic reaction or other unfitness after the treatment.10 patients who are hepatitis B related cirrhosis and 5 alcoholic cirrhosis, who had obvious asthenia, darkening of urine and midrange hydroperitoneum before the transplantation, have clinical symptom disappeared in 2 months after the operation.Conclusions1 Transplantion of bone marrow stem cell can improve liver function.2 Transplantion of bone marrow stem cell is effective method to cure Liver Cirrhosis. |
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