摘要
目的观察自体外周血干细胞(PBSC)移植治疗缺血性下肢血管病的临床疗效及相关影响因素.方法 62例自愿接受自体PBSC移植的患者中糖尿病足34例,动脉硬化闭塞症22例,血栓闭塞性脉管炎4例,结节性多动脉炎1例,雷诺病1例.发生足部溃疡或坏疽38例,合并感染14例.累及双下肢病变52例,其中3例患者移植前已行一侧肢体截肢术;单肢病变10例,共移植111条下肢.全部患者均给予重组人粒细胞集落刺激因子 450～600 μg/d,皮下注射,行PBSC动员5 d,第6天用血细胞分离机采集单个核细胞(MNC),总量82～148 ml,MNC数量(718.2～224.6)× 109/L.将MNC悬液按3 cm×3 cm距离进行缺血肢体移植术,术后第1天至6个月定期观察各项指标综合评估.结果 PBSC移植后7～30 d 54例(87.1%)疼痛有不同程度的缓解,7～30 d 56例(90.3%)患肢冷感明显改善,4～16周16例(40.0%)溃疡或足趾坏疽好转,感染得到控制;踝肱指数 12例(34.3%)有不同程度的改善,26例(42.3%)经皮氧分压改善,5例数字减影下肢动脉造影结果显示新侧支血管形成明显增加.2例糖尿病足合并脑梗死患者在干细胞动员期间症状加重,经治疗好转,其余患者未出现并发症和明显不良反应.结论自体PBSC治疗缺血性下肢血管病是一种安全、有效的手段,尤其对于下肢动脉没有流出道的患者有特殊意义,可使一部分患者免除截肢或降低截肢平面,改善生活质量.
Objective To observe the clinical efficacy of autologous peripheral blood stem cells (PBSC) transplantation in 62 cases with ischemic lower extremity disorder.Methods Totally 62 patients with 34 cases of diabetic foot and 28 cases of various lower extremity ischemic disorders received recombinant human granulocyte-macrophage colony-stimulating factor(rhGM-CSF)450-600 μg/d by hypodermic injection for 5 days to mobilize stem cells. On the sixth day, PBSC were collected by COBE 6.1 Spectra Version with an amount of 82-148 ml; the number of mononuclear cells( MNC)is (718.2-224.6)×109/L. CD+ 34 cells were tested. The PBSC were injected into the ischemic lower extremity and foot intramuscularly at 3 cm × 3 cm distance. The clinical and laboratory findings were monitored from first day to 24 th week.Results In 62 patients with PBSC transplantation , free of severe pain was found in 54 cases(87.1%) from 7 to 30 days, improvement of foot cool feelingin 56 patients(90.3%) from 7 to 30 days, improvement of foot ulcer in 16 cases(40.0%) from 4 to 16 weeks. Ankle/brachial index (ABI) increased in 12 cases(34.3%),TcPO 2 improved in 26 cases(42.3%). Digital subtraction angiographic scores were peformed in 5 patients after 8-12 weeks, there was formation of new collateral vessels. No related complication or adverse effect was observed except in 2 patients with diabetic foot and cerebral infarction exacerbation of symptoms during the process of stem cells mobilization in all process. Conclusion Auotologous PBSC transplantation might be a safe and effctive method for lower extremity ischemic disorder. It could improve the quality of life of many patients as amputation of lower extremity or foot might be avoided.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2005年第2期95-98,共4页
Chinese Journal of Internal Medicine
