经皮脾动脉自体骨髓细胞移植治疗2型糖尿病5例

Autologous bone marrow cell transplantation via spleen artery in 5 patients with type 2 diabetes mellitus

背景:近年来,不断有人尝试干细胞治疗糖尿病,尽管应用自体骨髓干细胞是众多手段中最简便而安全的方法,但目前尚无治疗2型糖尿病的正式报道,对糖尿病的治疗效果仅仅见于零星报道,目前还没有定论。目的:观察自体骨髓细胞经脾动脉移植治疗2型糖尿病的效果,探讨其可行性、安全性和有效性。方法:选取2009-03/07成都市温江区人民医院ICU科收治的5例急性心肌梗死合并2型糖尿病患者,并正在接受胰岛素联合口服降糖药物治疗,而血糖控制不理想,实施了自体骨髓细胞移植。①患者俯卧位局麻,双侧髂后上棘行多点穿刺,抽取骨髓血100～150mL,要求在60min内完成。将采集的骨髓血进行骨髓细胞分离、洗涤,用生理盐水稀释单个核细胞悬液至20～30mL。②经股动脉插管,送入4.0cm judkins5或6F右冠状动脉造影导管至腹腔干,调整导管方向进入脾动脉开口处,注入优维显5～10mL后确定导管位置,注入骨髓细胞悬液。③分别于移植后3,9个月进行随访血糖控制水平及胰岛素用量。结果与结论:试验选取5例冠心病合并2型糖尿病患者,移植全部成功并完成随访。①自体骨髓细胞移植过程中无需要处理的不良反应,2例有腹部发热感,1例有轻度恶心感。②与移植前相比,自体骨髓细胞移植后3,9个月血糖平均下降23%和27%。③与移植前相比,自体骨髓细胞移植后3,9个月每日胰岛素用量平均减少22%和42%。提示经皮脾动脉移植自体骨髓细胞,可降低2型糖尿病患者血糖水平及每日胰岛素用量,且安全可行。

BACKGROUND：Recently,more and more people try to use stem cells to treat diabetes mellitus.Application of autologous bone marrow stem cells is a simplest and safest method,but no reports have addressed autologous bone marrow stem cells for type 2 diabetes mellitus.There are several reports concerning the outcomes of diabetes mellitus treatment.Thus,there is no final conclusion at present.OBJECTIVE：To observe effectiveness of autologous bone marrow stem cells for type 2 diabetes mellitus via splenic artery transplantation,and to explore its feasibility,safety and validity.METHODS：A total of 5 patients with acute myocardial infarction and type 2 diabetes mellitus had been enrolled at the ICU Department,Wenjiang People＇s Hospital from March to July 2009.They received insulin combined with oral administration of sugar-reducing drugs,but blood sugar was not fully controlled,and then subjected to autologous bone marrow cell transplantation.①Patients received multipoint puncturation in the bilateral posterior superior iliac spine in a prone position following local anesthesia.A total of 100-150 mL bone marrow blood was collected.This test was accomplished within 60 minutes.Bone marrow cells were harvested from bone marrow blood,washed,and then diluted using saline into mononuclear cell suspension about 20-30 mL.②Through femoral artery intubation,4.0 cm judkins 5 or 6F right coronary arteriography catheter was inserted into the celiac trunk.The catheter direction was regulated,and the catheter entered splenic artery.Following injection of 5-10 mL ultravist,the catheter position was determined,and bone marrow cell suspension was inserted.③ Blood glucose levels and insulin dosage were followed up at 3 and 9 months following transplantation.RESULTS AND CONCLUSION：A total of 5 patients with coronary artery disease and type 2 diabetes mellitus received successfull transplantation and were followed up.①During autologous bone marrow cell transplantation,no adverse reaction was detected;two cases developed abdomen fever;one case suffered from light nausea.②Compared with pretransplantation,fasting blood glucose was reduced by 23% and 27% at 3 and 9 months after the transplantation.③Compared with pretransplantation,daily insulin requirement was significantly reduced by 22% and 42% at 3 and 9 months after the transplantation.These results have demonstrated that selective spleen arterial transplantation of autologous bone marrow cells is safe and can decrease blood glucose level and daily insulin dose in patients with type 2 diabetes mellitus.