| Objective:To evaluate the efficiency and safety of autologous bone marrow-derivedendothelial progenitor cells transplantation for end-stage liver diseases such as liverfailure through clinical controlled trials,so as to seek a new and effective therapeuticmethod,reduce the mortality of liver failure suffers,and increase the survival rate.Methods:According to relevant criterions,liver failure patients hospitalized in ourdepartment from August,2011to December,2012participate the EPCs transplantationgroup and control group in the context of informed consent.Each group consists of12patients,and patients of both groups are provided with conventional medical supportivetreatment.Autologous bone marrow of patients in the transplantation group is taken asthe donors,and cultured,separated,and identified in the GMP to obtain autologous bonemarrow-derived EPCs.These EPCs are transplanted into livers of patients throughhepatic artery intubation.Then compare clinical symptoms,liver function,bloodcoagulation function,and final prognosis of two groups of patients and observe whethercomplication occurs. Enzyme Linked Immunosorbent Assay(ELISA) is adopted fordetecting hepatocyte growth factor(HGF),transforming growth factorβ1(TGF-β1) in theserum of two groups of patients.Then the preliminary mechanism is discussed.Results:1.For patients of the EPC group,prothrombin time(PT),prothrombin timeactivity(PTA),and albumin(Alb),total bilirubin(TBil),direct bilirubin(DBil)begin torecover3~7days after operation;and the decrease ranges of TBil,DBil,Alb are generallyincreasing;clinical symptom of patients such as nause and abdominal distension beginto alleviate about3days after operation and disappear about2weeks after theoperation.2.For patient of the control group,various indexs begin to recover1~2weeks after being hospitalized,the recovery ranges are multivariate,clinical sympton of patientsbegin to allevizte about1week after being hospitalized,and disappear about3~4weeks.3.Comparing these two groups of patients with each other,the recovery speed ofEPC group is relatively fast and the inter-individual variability is relatively.However,ateach observation time point,but the values of P are all higher than0.05,which may beconnected with small sample capacity.4.According to cytokine concentration detected by ELISA,the HGF of the EPCgroup is increased and TGF-β1is decreased after operation.After7days oftransplantation,the HGF concentration of the EPC group is higher than that of thecontrol group,P<0.05;the TGF-β1concentration of the EPC group is lower than that ofthe control group,P>0.05.5.Two patients in each group shall be regarded as invalid cases because of theirleaving hospital without cure and loss to follow-up. Besides, one patient in the EPCgroup had his liver transplantation operation in another hospital11days after EPCtransplantation and shall be regarded as an invalid case as well. The rest patients are allalive after one-year follow-up.Conclusion:1.Preliminary evidence the isolation,culture and identification of EPC is feasibility,and the security of the process of bone marrow cellection and EPC transpantation.2.The recovery speed of patients in the EPC group is faster than that of patients inthe control group,which indicates that transplantation may speed up the recovery andcan shorten the length of disease.3.In the recovery process,HGF concentration of the transplantation group is higherthan that of the control group(the difference is with statistical significance),and theTGF congcentration is lower than that of the control group,which verifies priliminarilythe mechanism that EPCs transplantation in animal model can promote/inhibitautocrine or paracrine cell growth factor and promote liver cell regeneration. |
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