自体外周血干细胞和骨髓干细胞移植治疗糖尿病下肢动脉闭塞症52例效果比较

Autologous transplantation of bone marrow stem cells versus peripheral blood stem cells for treatment of diabetic lower limb ischemia: A comparative study in 52 cases

背景:无论是骨髓干细胞移植还是外周血干细胞移植治疗肢体缺血的疗效在动物实验和临床上均得到证实。然而,二者疗效谁更优秀?目的:多指标客观对比评估自体骨髓干细胞和外周血干细胞移植治疗糖尿病下肢动脉闭塞症的临床效果。设计、时间及地点:对比观察,临床病例分析,于2003-09/2008-01在河南省人民医院完成。对象:52例糖尿病下肢闭塞症患者,男27例,女25例,平均(69±6)岁。随机分为2组,自体骨髓干细胞移植组(n=30)和外周血干细胞移植组(n=22),方法:自体骨髓干细胞移植组(n=30)和外周血干细胞移植组(n=22),2组均接受内科综合治疗,在此基础上分别进行自体骨髓干细胞移植和外周血干细胞移植。主要观察指标:移植前后疼痛、冷感、间歇性跛行、踝肱指数变化。结果:移植2周后,2组患者下肢疼痛症状明显缓解率、好转率、无效率2组比较,差异均无统计学意义(P>0.01),冷感明显缓解率、好转率、无效率比较,差异均无统计学意义(P>0.01)。间歇性跛行明显缓解率、好转率、无效率2组比较,差异均无统计学意义(P>0.01)。踝肱指数变化2组比较,差异亦无统计学意义(P>0.01)。所有患者未出现并发症和不良反应。结论:自体骨髓干细胞和外周血干细胞移植治疗糖尿病下肢动脉闭塞症都是一种简便、安全、有效的治疗方法,疗效基本相当。

BACKGROUND： The outcome of bone marrow stem cell transplantation and peripheral blood stem cell transplantation for treating limb ischemia has been verified in animal experiments and clinic. However, whose outcome is better deserves further studies. OBJECTIVE： To compare the clinical outcome of autologous transplantation between bone marrow stem cells and peripheral blood stem cells for the treatment of diabetic lower limb ischemia. DESIGN, TIME AND SETTING： The controlled clinical case analysis was performed at the Henan Provincial People＇s Hospital from September 2003 to January 2008. PARTICIPANTS： Totally 52 patients with diabetic lower limb ischemia, 27 males and 25 females, with an average age of （69±6） years, were randomly divided into two groups, a bone marrow stem cell transplantation group （n=30） and a peripheral blood stem cell transplantation group （n=22）. METHODS： Patients in the two groups were treated with the same medical measures, and respectively treated with bone marrow stem cell and peripheral blood stem cell transplantation. MAIN OUTCOME MEASURES： Pain, cold feeling, intermittent claudication, and ankle-brachial index before and after transplantation. RESULTS： Two weeks after transplantation, no significant difference was detected in the percent of pain-relief （evidently, commonly, inefficacy） between both groups （P 〉 0.01）. There were no significant differences in the percent of cold-relief （evidently, commonly, inefficacy） （P 〉 0.01）. No significant difference was found in the percent of intermittent claudication relief （evidently, commonly, inefficacy） between both groups （P 〉 0.01 ）. There were no significant differences in ankle-brachial index between both groups （P 〉 0.01 ）. No related complication or adverse effects were observed in all patients. CONCLUSION： Autologous bone marrow stem cell and peripheral blood stem cell transplantation might be a simple, safe and effective method for lower limb ischemia. The clinical efficacy of two therapies is equivalent.