自体外周血干细胞移植术治疗重度下肢缺血19例临床分析

Clinical Analysis of Transplantation of Autologous Peripheral Blood Stem Cells for the Treatment of 19 Cases of Lower Limb Chronic Ischemia

目的：探讨自体外周血干细胞移植术治疗下肢缺血性疾病的治疗效果。方法：2004年6月-2009年7月治疗的19例下肢缺血性疾病患者，共23条患肢，8例接受2次手术，3例接受3次手术。其中复杂性动脉硬化性闭塞症8例，糖尿病足7例，血栓闭塞性脉管炎4例，采用重组集落刺激因子（惠尔血）注射动员后，采集外周血干细胞，注射到患肢肌肉组织，观察惠肢疼痛、跛行距离、冷感、溃疡愈合情况、踝肱指数（ABI）和动脉造影（DSA）的变化。结果：干细胞移植术后随诊1～60个月，平均28个月。全组患者症状好转、ABI升高；6例伴足部溃疡者4例溃疡愈合，2例溃疡明显缩小；5例伴足趾湿性坏疽转为干性坏疽；1例在术后3个月因缺血加重行膝上截肢术；4例患者术后DSA见广泛侧支循环建立；未出现严重并发症。结论：自体外周血干细胞移植术治疗下肢缺血性疾病安全、有效、患者痛苦小、易接受，对于严重下肢缺血且无良好流出道的病例可改善症状、保肢、降低截肢平面。

Objective：To study the effect of the transplantation of autologous peripheral blood stem cells for the treatment of 19 cases with lower limb chronic ischemia. Methods： The clinical of 19 cases of lower limb chronic ischemia with 23 diseased limbs in total from Jun. 2004 to ]ul. 2009 were analyzed. Among them, 8 cases received 2 operations each and 3 cases 3 opera- tions each, 8 cases was ill with sclerotic arterial occlusion,7 cases with diabetic feet and 4 cases with thromboangiitis obliter- ans. After mobilization of peripheral blood stem cells with recombinant human granulocyte colony stimulating factor injection, autologous peripheral blood stem cells were collected and injected into the muscular tissues of diseased limbs, and then the changes in pain, limping distance, cold feeling, ulcer healing, Ankle Brachial Index （ABI） and digital subtraction angiography （DSA） were observed. Results： The duration of follow up after transplantation of blood stem cells lasted for 1-60 months and 28 months on average. All the patients in the said group proved to look up, that is, ABI increased; of the 6 cases with ulcer in lower limb, 4 healed their ulcer while 2 obviously reduced their ulcer; 5 cases with wet gangrene of toes is changed into with dry gangrene of toes~ I case received above-knee amputation due to worsened chronic ischemia within 3 months of operation; 4 cases displayed widespread collateral circulation setup in post operation DSA; and no serious syndromes were found. Conclu- sion： The transplantation of autologous peripheral blood stem cells for the treatment of lower limb chronic ischemia is so safe and effective that patients are only a little painful and liable to accept it and it can improve symptoms, protect limbs, lower am- putation plane and prolong amputation time for the cases of serious chronic ischemia in lower limbs without good outflow tracts.