干细胞源性血管重建缺血态组织血供的临床研究

Compliance of Ischemic State Tissue on Stem Cells Derived Angiology for Secondary Blood Flow Remodeling

目的探讨自体外周血干细胞移植衍生的新生血管主导和完善缺血态组织二次血流重建的临床效果。方法选择2005年3～12月期间云南省血管外科中心收治的下肢缺血患者42例,第1次血流重建方法选择血管腔内修复术,第2次血流重建方法选择自体外周血干细胞移植术,于首次手术后3个月实施。第2次术后第4年随访。术前、术后观察均采用多功能监测仪、多普勒检测仪、经皮氧分压监测仪、数字减影血管造影仪等,并分别从皮肤、血管及血液3种组织层面测算肢体局部血流量变效应程度。结果自体外周血干细胞移植术后主观指标:小腿疼痛、冷凉感及静息痛缓解率均为100%;间歇性跛行距离为(1 600.3±310.1)m,长于术前的(520.3±160.6)m(F=5.84,P<0.05);足部疼痛缓解率为100%;保肢率为100%;肢体麻木感缓解率为100%。自体外周血干细胞移植术后客观指标:与术前比较,皮温指数(1.63±0.31比1.22±0.23,F=4.69,P<0.05)、经皮氧分压〔(37.61±9.52)mm Hg比(30.63±4.54)mm Hg,F=5.72,P<0.05〕、踝肱指数(0.93±0.23比0.33±0.24,F=6.72,P<0.05)、光电容积微血流态指数(0.81±0.12比0.23±0.05,F=5.68,P<0.05)、血氧饱和度〔(79.44±20.42)%比(42.43±10.41)%,F=5.68,P<0.05〕及数字减影血管造影评分(1.34±0.23比0.21±0.03,F=4.89,P<0.05)均有明显改善。结论干细胞源性新生血管量及其供给组织的持久有效的血流灌注量是主导和完善缺血态组织二次血流重建效应的主要生物学机理。

Objective To investigate the biological mechanism about autologous peripheral blood stem cell transplantation（ABSCT） derived neovascularization to lead and perfect the effect of ischemic state tissue of secondary blood flow remodeling.Methods Forty-two patients with critical limbs ischemia and 42 limbs in all from Mar.2005 to Dec.2005 in Yunnan Provincial Center of Vascular Surgery were selected,who treated by endovascular repair and ABSCT at the first flow reconstruction and the secondary flow reconstruction,respectively.The preoperative and postoperative effect degrees of limbs regional blood flow from cutaneous covering,blood vessel,and blood were measured by multifunction monitoring device,dopplor ultrasound monitoring device,percutem oxygen partial pressure（TcPO2）monitoring device and digital subtraction angiography（DSA）.The follow-up time was in four year after ABSCT. Results After ABSCT,the pain,cold or cool,and rest pain of leg were relieved.The distance of intermittent claudication after ABSCT was longer than that before ABSCT（（1 600.3±310.1） m versus（520.3±160.6） m,F=5.84,P 0.05）.The foot pain and limbs insensible feeling easement rates were 100% after ABSCT.Compared with before ABSCT,the objective effect indexes of limbs regional blood flow after ABSCT were significantly improved（skin temperature index：1.63±0.31 versus 1.22±0.23,F=4.69,P0.05;TcPO2：（37.61±9.52） mm Hg versus（30.63±4.54） mm Hg,F=5.72,P0.05;ankle-brachium index：0.93±0.23 versus 0.33±0.24,F=6.72,P0.05;photoplethysmography index：0.81±0.12 versus 0.23±0.05,F=5.68,P0.05;saturation of blood oxygen：（79.44±20.42）% versus（42.43±10.41）%,F=5.68,P0.05;DSA score：1.34±0.23 versus 0.21±0.03,F=4.89,P0.05）.Conclusions The results strongly suggest that the ABSCT can promote blood flow remodeling in limbs ischemia,and stem cells derived neovascularization can significantly offer effective and permanent blood flow perfusions to the ischemic state tissue,and this biological effect play an important role in the ischemic state tissue for secondary blood flow remodeling.