骨髓单个核细胞和外周血单个核细胞移植治疗外周动脉病的疗效分析

Effects of Bone Marrow Monouclear Cells Implantation and Peripheral Blood Mononuclear Cells Implantation in Treatment of Peripheral Arterial Disease

目的 观察自体骨髓单个核细胞（BMMNCs）移植、粒细胞集落刺激因子（G-CSF）动员的自体外周血单个核细胞（PBMNCs）移植治疗外周动脉病的临床疗效。方法 将69例外周动脉病患者随机分成3组：G-CSF动员的自体PBMNC移植组（PBMNC组）30例,给予G-CSF 600mg/d,皮下注射,连用4d,第5d采集PBMNCs移植至患肢;自体BMMNC移植组（BMMNC组）15例,采集骨髓液500～800ml,分离BMMNCs移植至患肢;常规内科治疗组（对照组）24例,仅给予常规药物治疗。术后3月随访所有患者,观察评价各项指标。结果PBMNC组CD34＋细胞数[（3.31±1.39）×10^6/kg]显著多于BMMNC组[（1.42±0.42）×10^6/kg,P〈0.01）]。移植后3月时复查,PBMNC组和BMMNC组的静息痛改善率分别为76.67%和73.33%均显著高于对照组16.67%（P〈0.01）;PBMNC组的溃疡改善率为40.0%,BMMNC组为42.86%,与对照组比较差异均无统计学意义（P〉0.05）;两个移植组之间静息痛改善率和溃疡改善率差异均无统计学意义（P〉0.05）。两个移植组术后3月时,最大无痛步行距离（MWD）、踝臂压指数（ABI）,经皮氧分压（TcO2）均明显高于治疗前（P〈0.01）,对照组治疗前后无差异（P〉0.05）。△MWD、△ABI、△TcO2分别指治疗前和治疗后3月时MWD、ABI、TcO2的差值,比较两个移植组[（108.75±66.70）m vs（113.75±63.86）m,（0.082±0.05）vs（0.077±0.051）,（10.54±5.90）mm Hg vs（9.63±5.26）mm Hg）]差异均无统计学意义（P〉0.05）。PBMNC组和BMMNC组的DSA显效率分别为66.67%和62.50%均显著高于对照组0%（P〈0.01,P〈0.05）。两个移植组之间无差异（P〉0.05）。结论 自体PBMNC移植和自体BMMNC移植均为治疗外周动脉病安全有效的新方法,两者疗效相当。

Objective To observe the clinical efficacy of autologous implantation of bone marrow mononuclear cells （BMMNCs） and granulocyte colony - stimulating factor （ G - CSF） mobilized peripheral blood mononuclear cells （（ PBMNCs ） in treatment of peripheral arterial disease （PAD）. Methods Sixty -nine patients with PAD were randomly assigned to 3 groups： the PBMNC group （ n = 30）, BMMNC group （n = 15 ）, and the control group （n = 24）. In the PBMNC group, after administration of G-CSF（600mg/d） by subcutaneous injection for 4 days, PBMNCs were harvested and implanted into the ischemic limb on the fifth day;In the BMMNC group,between 500 and 800ml of bone marrow was collected from each patient, BMMNCs were separated and implanted; the control group was treated with conventional drug therapy only. All of the patients were followed up after at least 3 months. Results The number of implanted CD34^＋ cells in the PBMNC group [ （ 3.31±1.39） ± 10^6/Kg] were significantly more than the BMMNC group[ （ 1.42 ± 0. 42）× 10^6/Kg, P 〈 0. 01]. At the end of the 3 - months follow - up, the improvement rate of rest pain was 76. 67% and 73.33% in PBMNC group and BMMNC group respectively,both were significantly higher than that of the control group （16.67%, P 〈0. 01 ） ,and there were no significant difference between implantation groups （P 〉 0. 05）. The improvement rate of ischemic ulcer was 40.0% and 42. 86% and 8.33%in PBMNC group and BMMNC group and control group respectively, and there were no differences among three groups （P 〉 0.05 ）. Three months after treatment, the maximum pain -free walking distance （MWD）, and ankle -brachial pressure index （ABI） and transcutaneous oxygen pressure （TcO2 ） increased significantly in implantation groups （P 〈 0. 01 ）, but no such impovements were seen in the control group （P 〉 0. 05）. The A MWD, A ABI, A TcO2 were defined as the change in MWD, ABI, TcO2 between the pre - treatment measurement and that obtained three months after treatment, and were （108.75 ±66. 70）m vs（113.75 ±63.86）m, （0.082±0.05） vs（0. 077±0.051） ,（10.54 ±5.90） mm Hg vs（9.63±5.26）mm Hg in the PBMNC group and the BMMNC group respectively, and there were no significant difference between both groups （P 〈 0.05 ）. The effective rate of digital subtraction angiography（DSA） was 66.67% and 62.50% in the PBMNC group and BMMNC group respectively, and both were remarkedly higher than that in the control group （ P 〈 0. 01, P 〈 0. 05） and there were no difference between implantation groups （P 〉 0. 05 ）. Conclusion Both the autologous implantation of BMMNCs and the autologous implantation of G - CSF - Mobilized PBMNCs were safe, effective, and novel therapeutic approach for PAD.