自体外周血干细胞移植与髓芯减压治疗系统性红斑狼疮并股骨头缺血性坏死

Autologous peripheral blood stem cell transplantation combined with core decompression for the treatment of avacscular necrosis of the femoral head in patients with systemic lupus erythematosus

背景:自体外周血干细胞移植联合髓芯减压与单纯髓芯减压治疗系统性红斑狼疮合并股骨头缺血坏死的疗效是否不同,相关报道较少。目的:观察自体外周血干细胞移植联合髓芯减压治疗系统性红斑狼疮合并股骨头缺血性坏的临床疗效。方法:选择2004年10月至2014年10月在福建医科大学附属龙岩第一医院住院的系统性红斑狼疮合并股骨头缺血性坏死患者,按治疗方法不同分为移植组(n=22)和对照组(n=26),分别采用自体外周血干细胞移植联合髓芯减压治疗和单纯髓芯减压治疗。结果与结论:与治疗前相比,移植组患者治疗后1周白细胞、红细胞沉降率、C-反应蛋白、补体C3、补体C4水平明显上升,且治疗前后谷丙转氨酶、谷草转氨酶、碱性磷酸酶、血肌酐、尿酸、Ig M、Ig G、Ig A、ds-DNA水平均在正常范围。与对照组相比,治疗组患者治疗后Harris评分(6,12,24个月)升高,目测类比评分(12,24个月)降低,且MRI T1信号区所占股骨头体积的百分比降低。提示自体外周血干细胞移植联合髓芯减压治疗系统性红斑狼疮合并早中期股骨头缺血性坏死疗效优于单纯髓芯减压,可显著减轻患者关节疼痛,改善股骨头血液供应,明显恢复关节功能,有效防止股骨头进一步塌陷,是安全有效的保头治疗方法。

BACKGROUND： There are less studies addressing whether the clinical outcomes about the autologous peripheral blood stem cell transplantation combined with core decompression for the treatment of systemic lupus erythematosus with avascular necrosis of the femoral head are different from the simple core decompression. OBJECTWE： To observe the clinical outcomes of autologous peripheral blood stem cell transplantation combined with core decompression for the treatment of systemic lupus erythematosus with avascular necrosis of the femoral head. METHODS： Systemic lupus erythematosus patients with avascular necrosis of the femoral head admitted at the Affiliated Longyan First Hospital of Fujian Medical University from October 2004 to October 2014 were enrolled and divided into transplantation group （n=22） and control group （n=26） according to different therapies. Patients in the two groups were subjected to autologous peripheral blood stem cell transplantation combined with core decompression and simple core decompression, respectively. RESULTS AND CONCLUSION： In the transplantation group, the levels of white blood cells, C-reactive protein,C3 and C4 as well as erythrocyte sedimentation rate were significantly increased at 1 week after treatment, while the levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, serum creatinine, uric acid, IgM, IgG, IgA, ds-DNA levels still maintained in the normal range. Compared with the control group, the Harris scores were increased （6, 12, 24 months after treatment） and visual analog scale scores were reduced （12, 24 months after treatment） in the transplantation group after treatment. Moreover, the necrosis area of the femoral head shown on the T1W1 of MRI in the transplantation was also smaller than that in the control group. These findings indicate that the autologous peripheral blood stem cell transplantation combined with core decompression for the treatment of systemic lupus erythematosus with avascular necrosis of the femoral head can remarkably relieve the pain, promote the blood supply in the necrosis area, ameliorate the hip joint function, and prevent the collapse of the femoral head, which is an easy and safe treatment preserving the femoral head in systemic lupus erythematosus patients with avascular necrosis of the femoral head in early and middle stages.