摘要
目的探讨自体外周血干细胞移植治疗血栓闭塞性脉管炎(TAO)的疗效及安全性。方法对我院2007年4月至2011年12月期间收治的50例TAO患者(62条患肢)行自体外周血干细胞移植术,采用主观指标包括患肢疼痛、冷感以及客观指标包括间歇性跛行距离、踝肱指数(ABI)、足部溃疡变化、皮温进行疗效评价。结果 4例患者(4条患肢)移植后3周因小腿中段以下出现坏死导致低位截肢;46例保肢患者(58条患肢),移植后1个月,小腿疼痛及冷感觉均消失,足部疼痛和冷感评分均优于移植前(P<0.05)。移植后3个月,10例(10条患肢)溃疡全部愈合;46例保肢患者,间歇性跛行距离由(80.38±45.53)m增加到(330.56±142.31)m,下肢皮温由(26.50±0.46)℃增加到(31.49±0.45)℃,ABI由0.41±0.02增加到0.71±0.05,移植后以上三项指标均明显优于移植前(P<0.05)。移植后6个月,46例保肢患者58条患肢动脉造影,均有不同程度的新生侧支血管形成。所有患者经实验室或CT检测,均未发现恶性肿瘤、视网膜增生、动脉瘤等并发症。40例患者移植后随访9～36个月(平均22.5个月)症状改善后无加重;6例患者6个月后因下肢疼痛加重,疼痛评分为4分,并伴有足趾溃疡,再次行外周血干细胞移植,再次移植后18个月,患者仅有下肢乏力,疼痛改善,疼痛评分为1分,足趾溃疡愈合,无间歇性跛行。结论自体外周血干细胞移植治疗TAO是一种简单、安全、有效的方法,尤其是下肢远端动脉流出道差无法进行搭桥的患者,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 investigate the efficiency and safety of autologous peripheral blood stem cell transplantation（ABSCT）in treatment for thromboangiitis obliterans.Methods Fifty patients（62 affected limbs）with thromboangiitis obliterans were treated by ABSCT.A series of subjective indexes including improvement of pain and cold sensation and objective indexes including intermittent claudication distance,ankle brachial index（ABI）,skin temperature,and improvement of foot skin ulcer were evaluated.Results Due to necrosis in middle and lower part of leg,4 of 50 patients（4 lower limbs）were taken extremity amputation on 3 weeks after ABSCT,46 patients kept their legs successfully.On 1 month after ABSCT,the legs pain and cold sensation of 46 patients（58 affected limbs）vanished,and the score of feet pain and cold sensation after ABSCT were better than those before ABSCT（P0.05）.The intermittent claudication distance,skin temperature,and ABI of 46 patients with kepting their legs on 3 months after ABSCT significantly increased as compared with before ABSCT〔intermittent claudication distance（：80.38±45.53）m versus（330.56±142.31）m;skin temperature（：26.50±0.46）℃ versus（31.49±0.45）℃;ABI：0.41±0.02 versus 0.71±0.05〕,the differences were statistically significant（P0.05）.Six months after ABSCT,different degree neonatal lateral vessels were found in 58 affected limbs of 46 patients by lower extremity arteriography.The complications were not found in all the patients by laboratory or CT detection,such as malignant tumors,retinal hyperplasia,aneurysm and so on.After ABSCT,40 patients were followed up for 9 to 36 months（mean 22.5 months）,the symptom had improved.Due to leg pain aggravated after 6 months,score of pain feelings was 4 in 6 patients and with toe ulcers,who had ABSCT again.Eighteen months after transplantation,the patients had only debilitation of lower extremity.The pain feeling was improved（score of pain feeling was 1）.The toe ulcer was healed and no angiosclerotic myasthenia happened.Conclusions ABSCT is a simple,safe,and effective method,especially in treatment for patients with severe lower limb ischemia who is no arterial reconstruction is feasible.It could improve the quality of life of patients and might be avoided amputation of lower extremity or foot.
出处
《中国普外基础与临床杂志》
CAS
2012年第11期1187-1190,共4页
Chinese Journal of Bases and Clinics In General Surgery
基金
云南省自然科学基金(编号:2010ZC219
2011FB150)
云南省学术与技术带头人后备人才基金(编号:2008PY044)~~
关键词
自体移植
外周血干细胞
下肢缺血
Autologous transplantation
Peripheral blood stem cell
Lower ischemia
