应用彩色超声多普勒评价干细胞移植治疗老年糖尿病下肢动脉闭塞症的疗效

Evaluation on curative effect of stem cell transplantation for elderly diabetes combined with lower limb artery obturation by color doppler ultrasound

目的通过观察彩色超声多普勒对自体干细胞移植(PBSCT)前后下肢动脉病变的改善情况,探讨超声多普勒在评价PBSCT治疗老年糖尿病下肢动脉闭塞症疗效的临床价值。方法确诊老年糖尿病合并下肢动脉闭塞症患者33例,采用重组人粒细胞集落刺激因子(rhG-CSF)150μg/d皮下注射,进行干细胞动员并分离,将干细胞悬液肌内注射进行双下肢移植(3×109细胞/肢)。术后观察3个月～1年,采用彩色超声多普勒观察移植前后管腔内径大小、内膜-中层厚度(IMT)、斑块直径并测量足背动脉血流速度、踝臂指数(ABI)。结果移植后患者临床症状改善,彩色多普勒超声测量足背动脉血流速度[(8.08±2.66)vs(10.44±3.58)]及ABI[(0.67±0.19)vs(0.89±0.12)]有所增加,差异均有高度统计学意义(均P<0.01)。移植后下肢动脉管腔内原有斑块无明显变化,内膜厚度如前,差异均无统计学意义(均P>0.05)。闭塞动脉周围侧支血管彩色血流较前增多。结论彩色超声多普勒可准确、快速检测和评价干细胞移植前后下肢血运改善情况,在评价干细胞移植治疗老年糖尿病下肢动脉闭塞症疗效方面能为临床提供可靠的诊断依据。

Objective To evaluate improvement status of self stem cell transplantation for elderly diabetes combined with lower limb artery obturation using color doppler ultrasound and to explore its clinical value.Methods 33 elderly patients with diabetes combined with lower limb artery obturation were selected.Recombinant human granulocyte-colony stimulating factor（rhG-CSF）（150 μg/d） was used to be subcutaneous injected,and stem cells were mobilized and separated,then stem cells suspension was injected intramuscularly into both lower extremities（3×109 per limb）.The clinical and laboratory findings were monitored and followed for 3 months to 1 year after the operation,and items were evaluated by color doppler ultrasound simultaneously,including the internal diameter and IMT,size of plaque,peak velocity of dorsal artery and ankle-brachial index（ABI）.Results The clinical symptoms were improved after stem cells transplantation.Peak systolic velocity [（8.08±2.66） vs（10.44±3.58）] and ABI [（0.67±0.19） vs（0.89±0.12）] were measured by color doppler ultrasonograph in diseased extremities,and the differences were all statistically significant（all P 0.01）.The size of original carotid plaque and intima thickness were found no obvious changes,the differences were all not statistically significant（all P 0.05）.Color bloodstream of collateral vessels was found have a increase surrounding obstructed artery.Conclusion Color doppler ultrasound can exactly and rapidly examine and assess blood transport improvement in the lower limbs after stem cell transplantation.It also provides reliable evidences for the diagnosis on the self stem cells transplantation for treatment of elderly diabetes combined with lower limb artery obturation.