干细胞移植治疗下肢动脉闭塞症

Autologous peripheral blood stem cell transplantation for the treatment of lower extremity arterial occlusive disease

目的探讨闭塞性动脉病再生治疗的临床应用新进展,评价动员后自体外周血干细胞移植治疗下肢动脉闭塞症的临床疗效及部分影响因素。方法血管造影确诊的下肢动脉闭塞症患者12例,经重组人粒细胞集落刺激因子(rhG-CSF)皮下注射150μg/d进行干细胞动员后,第5天用血细胞分离机采集分离干细胞,以3×109细胞/患肢对患肢进行肌肉注射,术后观察3个月至1年,进行各项指标综合评估。结果移植后3个月12例患者疼痛、患肢冷感、间歇性跛行及溃疡明显好转(按移植前后打分结果,P<0.01),选患肢相对恒定位置观测肢体血流图血流波幅[移植前(2.65±1.06)mm、移植后(7.76±0.59)mm,P<0.01]及血管超声血流灌注量[移植前(21.32±0.63)cm/s、移植后(44.55±4.13)cm/s,P<0.01],干细胞移植后血流灌注明显改善,血管造影示新生侧支血管明显增多,12例均未发现并发症和不良反应。结论采用动员后的外周血干细胞移植治疗下肢动脉闭塞症安全、有效,值得推广应用和深入研究。

Objective To evaluate the safety and feasibility of autologous peripheral blood mononuclear cells （PBMNCs） implantation after granulocyte-colony stimulating factor （G-CSF）-induced mobilization in patients with lower extremity arterial occlusive disease （AOD）. Methods A total of 12 patients with AOD were enrolled in this study. Following administration of rhG-CSF （150 μg/d） for 5 days, PBMNCs were harvested and injected intramuscularly in the diseased extremities （3 × 10^9 per limb）. Results One patient received left leg amputation due to uncontrolled ulcer 15 days post PBMNCs transplantation and the symptoms and signs were improved significantly in 9 patients and the symptoms and signs remained unchanged in another 2 aged patients （ 〉 70 years）. Doppler ultrasonography measurement showed that peak systolic velocity in diseased extremities was significantly increased post transplantation [ （44.55±4.13） cm/s vs. （21.32 ±0.63） cm/s, P 〈0.01]. Contrast lower limb angiogram showed increased collateral vessels post transplantation. One aged patient （80 years） who did not respond to autologous PBMNCs received heterologous PBMNCs transplantation （ PBMNCs was harvested from a young relative of him） 3 months post autologous PBMNCs transplantation and observed for another 3 months and all observed parameters improved significantly. Conclusion Implantation of autologous PBMNCs collected after G-CSF administration might offer a simple, safe, and effective therapy for the AOD patients.