动员后PBMC移植用于糖尿病与非糖尿病下肢动脉缺血性疾病治疗的效果比较

Effectiveness comparison of the mobilized PBMC transplantation on diabetic and non-diabetic patients with lower limbs ischemia

目的探讨动员后外周血单个核细胞治疗糖尿病下肢动脉缺血性疾病的疗效及机制。方法选择糖尿病性下肢动脉缺血性疾病患者23例(糖尿病组),非糖尿病性下肢动脉缺血性疾病患者36例(非糖尿病组),两组均行骨髓干细胞动员后自体外周血单个核细胞移植治疗。计数两组动员前后外周血单个核细胞数、CD34+细胞数,观察两组治疗前、治疗后7 d、治疗后4个月临床疗效评分(静息痛、冷感、无痛行走距离、组织缺损)。结果两组治疗后4个月静息痛、冷感、无痛行走距离、组织缺损评分均低于治疗前,P均<0.05;两组治疗后疗效评分比较无统计学差异。糖尿病组动员前外周血单个核细胞数及CD34+数量均明显低于非糖尿病组,动员后两组均升高且无显著差异。结论动员后自体单个核细胞移植治疗糖尿病下肢动脉缺血性疾病疗效确切,机制可能与动员后单个核细胞含有更早期的内皮干祖细胞并能提供干祖细胞增殖必需的微环境相关。

Objective To investigate the effectiveness and mechanism of mobilized peripheral blood mononuclear cells（PBMCs）transplantation on the diabetics patients with lower limbs ischemia.Methods Twenty-three diabetics patients with lower limbs ischemia（diabetes group） and 36 non-diabetics patients with lower limbs ischemia（non-diabetes group）were included,and then were treated with mobilized PBMCs transplantation.All patients were counted the numbers of PBMCs and CD34^＋ cells before and after mobilization,also were evaluated with symptoms scores（rest pain,cold feeling,no-pain walking distance and ucler） before and 7 days,4 months after therapy.Results The scores of rest pain,cold feeling,no-pain walking distance and ulcer in the two groups of 4 months after therapy were less than those before therapy,all P〈0.05;no difference of symptoms scores were found between the two groups.The number of PBMCs before mobilization of the diabetes group and CD34^＋ cells were both lower than those of the non-diabetes group,both indexes decreased after the mobilization and no difference were found between the two groups.Conclusion The effectiveness of PBMCs transplantation on diabetics patients is definite,the mechanism I may related to that the mobilized PBMCs including more earlier endothelial progenitor cells（EPCs） and can offer the microenvironment for the proliferation of EPCs.