自体干细胞移植治疗糖尿病足胰岛功能变化研究

The Research of Islets Function Change before and after Transplantation of Autologous Stem Cell in the Treatment of Diabetic Foot

目的探讨自体干细胞移植治疗糖尿病足胰岛功能的变化。方法 选择糖尿病足患者125例。术前采用胰岛素控制血糖,根据血糖控制情况分为两组:1组为全天血糖完全达标(三餐前血糖<5.6 mmol/L,餐后2 h血糖<7.8 mmol/L)63例;2组为全天血糖均高于正常(三餐前血糖<9～10 mmol/L,餐后2 h血糖<12～16 mmol/L)62例。均采用骨髓间质干细胞治疗糖尿病足。观察患肢的麻木、疼痛感、冷感、间歇性跛行是否好转,同时检测术后3d、1周、2周、1个月、3个月的餐前及餐后2 h血糖、C-肽值,同时观察外用胰岛素用量的变化。观察有无不良反应发生。结果术前1组患者餐前和餐后2 h血糖较2组均明显降低,差异有统计学意义(P<0.05);术后3 d、1周、2周、1个月、3个月1组与2组患者餐前及餐后2 h血糖比较,差异均无统计学意义(P>0.05)。术后3 d两组患者胰岛素用量较术前均明显降低,差异有统计学意义(P<0.05)。术前1组患者胰岛素用量较2组无明显降低,差异无统计学意义(P>0.05);术后3 d、1周、2周、1个月、3个月2组患者胰岛素用量较1组均明显降低,差异有统计学意义(P<0.05)。术前、术后3 d、1周、2周、1个月、3个月餐前和餐后2 h两组患者血C-肽水平比较,差异均无统计学意义(P>0.05)。结论自体骨髓干细胞在糖尿病患者体内可以部分分化为胰岛β细胞,分化的程度可能与移植前全天血糖水平有关。

Objective To study the autologous bone marrow stem cells in diabetes whether can be converted into functional islet beta cells. Methods 125 patients with diabetic foot were selected.Before the operation,with oral glucose tolerance test,the dosage of OHA and insulin,the C-peptide before and two hours after dinner to evaluate the recession of islet beta cells of diabetes.Before the operation,with insulin control blood sugar.The diabetes were divided into two groups according to the level of their glucose.Group 1：All the blood sugar was in the normal range（blood sugar before dinners was under 5.6 mmol/L,and after dinners under 7.8 mmol/L）.Group 2：All the blood sugar was over the normal range slightly（glucose before dinners was from 9 to 10 mmol/L and after dinners from 12 to 16 mmol/L）.We mobilized bone marrow stem cells three days before operation with G-CSF,then gather the marrow 180-200 ml,separate and retransfusion to the body.Detecting the C-peptide before and after three meals and observing the changing of external insulin dosage after three days,one week,two weeks,one month and three months after operation. Results The glucose of the two groups were obviously decrease after the operation,but the difference had no statistical significance（P〉0.05）.The insulin dosage of two groups declined significantly,the difference had statistical significance（P〈0.05）.The C-peptide level rise gradually,the difference had no statistical significance（P 〉0.05）. Conclusion Autologous bone marrow stem cells in diabetes can part convert into islet beta cells,which is contact with the level of full-day glucose and the motion degree of past operation.