自体骨髓干细胞移植治疗下肢慢性缺血性疾病的疗效观察
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唐新华E-mail:zengzhaofan888@163.com

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Obervations on the clinical efficiency of autologous bone marrow stem cell transplantation on chronic ischemic disease of lower limb
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    摘要:

    目的:探讨自体骨髓干细胞移植应用于下肢慢性缺血性疾病的临床疗效评价其疗效。
    方法:分析应用自体骨髓干细胞移植法治疗的下肢慢性缺血性疾病患者40例的临床资料。将患者随机等分为2组。第1组采用自体骨髓干细胞下肢肌内注射法移植,第2组采用下肢动脉腔内注射法移植。患者在抽取骨髓前均使用粒细胞集落刺激因子(GCSF)动员骨髓细胞2~3 d,300 μg/d,动员末日抽取骨髓血200 mL,经分离纯化后移植入患肢(双下肢患者选取症状重侧)。每月定期电话随访症状的变化。6个月后复查皮温、经皮氧分压(TcPO2)、踝肱指数(ABI)、数字减影血管造影(DSA),随访内容包括疼痛、冷感、麻木、跛行距离、溃疡坏疽情况。
    结果:全部患者获得随访,移值后6个月各项观察指标与移植前对比,患肢皮温、TcPO2变化差异有统计学意义(P<0.01);ABI变化差异无统计学意义(P>0.05);侧支循环再生及临床症状各指标总有效率均≥60%。无严重并发症发生。
    结论:经动员刺激后的自体骨髓干细胞移植治疗下肢慢性缺血性疾病是一种简单、安全、有效的方法。

    Abstract:

    Objective:To explore the application of autologous bone marrow stem celI transplantation in the treatment of chronic ischemic disease of lower extremity and evaluate the effect.
    Methods:Forty patients with chronic ischemic limbs were treated from January 2008 to April 2009. The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte macrophage colony-stimulatory factor(GCSF), 300μg /d, for 2-3 days. Then,200 mL of bone marrow was withdrawn from the iliac spine and the stem cells were obtained. After the bone marrow separation and purification, they were transplanted into the more severely ischemic limb.  After the transplantation, they were foIlowed up by phone once a month for six months. The skin temperature, transcutaneous oxygen pressure(TcPO2), digital subtraction angiography(DSA)and ankle/brachial index(ABI)were rechecked at 6 months later, and the symptoms of pain, cold, numbness, intermittent claudication and physical signs of ulcer and gangrene were also evaluated. 
    Results:All of the 40 patients were followed-up. At 6 months post-transplantation, the various indices were compared with before transplantation.(1)The skin temperature and TcPO2 had significante improvement (P<0.01).(2)ABI had no statistical significance (P>0.05).(3)DSA and all of the clinical symptoms showed general improvement in more than 60% of cases.(4)There were no serious complications.
    Conclusions: Transplantation of stimulated autologous bone marrow stem cells is effective in the treatment of ischemic disease of lower limb, which is a simple, safe and effective treatment for ischemic disease of lower limb.

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曾昭凡| 唐新华| 熊吉信| 张明芳.自体骨髓干细胞移植治疗下肢慢性缺血性疾病的疗效观察[J].中国普通外科杂志,2010,19(6):646-650.
DOI:10.7659/j. issn.1005-6947.2010.06.014

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  • 收稿日期:2009-12-08
  • 最后修改日期:2010-03-24
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  • 在线发布日期: 2010-06-15