骨髓动员后的自体骨髓血干细胞移植治疗糖尿病下肢血管病变疗效观察

The oberservation of diabetic vascular lesion of lower limbs treated with body marrow blood stem cell transplant after bone marrow mobilization

目的观察骨髓动员刺激后的自体骨髓血干细胞移植治疗糖尿病下肢血管病变的临床疗效。方法应用骨髓动员后的自体骨髓血干细胞移植治疗远端流出道狭窄的糖尿病下肢血管病变患者共18例,男15例,女3例,年龄52～76岁,平均66.2岁,糖尿病病程4～22年,平均14.6年。18例患者中共有患肢33条。所有患者均予重组人粒细胞集落刺激因子150～300μg/d皮下注射,使手术日WBC达30.0×109/L(不超过50.0×109/L)。然后在严格无菌操作下,行局部麻醉,自髂后上棘抽取骨髓血200ml左右,在百级操作间,用密度梯度离心法分离提纯出自体骨髓干细胞悬液40～50ml,在硬膜外麻醉或静脉全麻下,于患肢小腿沿血管走行方向自上而下予以肌肉注射。结果观察3个月,33条患肢麻木、冷凉缓解率为100%;疼痛缓解率为89.7%;间歇性跛行缓解率为47.1%;行走间距延长率为52.9%;溃疡愈合率为66.7%;坏疽好转率为50%;有2例2条患肢坏疽截肢平面降低;踝肱动脉指数(ABI)改善率75.8%。本组病例未发现其他并发症及不良反应。结论骨髓动员刺激后的自体骨髓血干细胞移植治疗糖尿病下肢血管病变方法简便、安全、有效。

Objective To observe the therapeutic efficacy of diabetic vascular lesion of lower limbs for the treatment of body marrow blood stem cell transplant stimulated by bone marrow mobilization. Methods 18 cases of patients with distal outflow artery stenosis were treated by the therapy of body marrow blood stem cell transplant. The patients, 15 cases of male and 3 cases of female, were between the age of 52 to 76, with an average age 66. 2 years. The course of diseases was different from 4 to 22 years, with an average duration of 14. 6 years. There were 33 affected limbs among the 18 cases. All sufferers were received recombinant human granulocyte colony stimulating factor 150 -300μg/d by hypodermic injection. The WBC court during the day before operation was 30. 0 x 109/L, which was no more than 50. 0×10^9/L. Then the sufferers were under local anaesthesia in rigorous sterile condition. Almost 200 ml bone marrow blood was abstracted from spina iliaca posterior superior. After that, 40 - 50 ml body marrow blood stem cell suspension was purified at class 100 clean room by u- sing density gradient centrifugation method. After epidural anesthesia or total intravenous anaesthesia, the suspension was injected intramuscularly in the affected leg according to the direction the blood vessel. Result Three months later, response rate of the 33 numb and cold limbs was 100%. The remission rates of pain and intermittent limp were 89. 7% and 47. 1% respectively. The elongation rate of walking distance was 52. 9%. The ulcer healing rates was 66.7%. The gangrenous improvement rate was 50%. The plane of amputation of 2 affected limbs in 2 cases was lower than the one before treatment. The improvement rate of Ankle-Brachial Index （ABI） was 75.8%. No complication and adverse reaction was observed in all the cases. Conclusion The therapy of diabetic vascular lesion of lower limbs treated with body marrow blood stem cell transplant after bone marrow mobilization is convenient, safe and effective.