自体骨髓单个核细胞移植治疗糖尿病性下肢缺血83例

Autologous transplantation of bone-marrow mononuclear cells for treatment of diabetic lower limb ischemia in 83 cases

背景：自体骨髓单个核细胞移植治疗糖尿病周围血管病变是目前广泛开展的一项技术,对缺血性病变有较好的效果,有个案报道对周围神经损伤所致临床症状有改善作用。目的：观察自体骨髓单个核细胞移植前后糖尿病足病患者缺血性及神经性病变指标的变化。方法：行自体骨髓单个核细胞移植治疗的糖尿病足病患者 83 例 153 条肢体。每例患者抽取自体骨髓 250~400 mL,经密度梯度法提取单个核细胞,提取的单个核细胞数量为 1.01×108~4.96×109个,平均数量为（2.04±0.53）×108个,稀释后双下肢肌肉内注射,每点 1~3 mL,间隔约 3 cm。移植后 3,6 个月进行缺血性指标和神经病变指标检测。结果与结论：自体骨髓单个核细胞移植后增加了双下肢血流量和外周血管数量,延长了行走距离,提高了皮温,促进了溃疡的愈合。治疗 3 个月及 6 个月后均有明显效果,差异有显著性意义。治疗 6 个月后,还可以改善糖尿病周围神经的自觉症状,增加运动及感觉神经传导速度,差异有显著性意义。

BACKGROUND：Autologous transplantation of bone-marrow mononuclear cells for treatment of diabetic peripheral angiopathy has been widely developed at present,which showed good curative effect on ischemic lesions.Case reports also showed that it could improve symptoms of peripheral neuropathy.OBJECTIVE：To observe the effect of before and after autologous transplantation of bone-marrow mononuclear cells on ischemic lesions and neuropathy index.METHODS：A total of 83 patients（153 legs） with lower extremity ischemia were treated with autologous transplantation of bone-marrow mononuclear cells.250-400 mL autologous bone marrow blood of each patient was distilled.Mononuclear cells were extracted by the density gradient method and the number of mononuclear cells were 1.01×108-4.96×109（average 2.04±0.53×108）.Mononuclear cells were injected into both lower extremities and foot intramuscular（1-3 mL/site） for 3cm distance after dilution.Ischemic index and neuropathy index were detected at 3,6 months after transplantation.RESULTS AND CONCLUSION：After autologous transplantation of bone-marrow mononuclear cells,the lower limb blood flow and collateral vessels were increased,walking distance was extended,skin temperature was elevated,and the healing of ulcer was promoted.There were significant differences between pre-transplantation and post-transplantation（3 and 6 months after）.After treatment for 6 months,the ational symptom of diabetic peripheral nerve was improved,the conduction velocity of motor nerves and sensory nerves was elevated,and there were significant differences between pre-transplantation and post-transplantation（after 6 months）.