脐带间充质干细胞移植对糖尿病肾病的临床观察

Clinical effect of umbilical cord mesenchymal stem cell transplantation on the treatment of diabetic nephropathy

目的探讨脐带间充质干细胞(UCMSC)移植治疗糖尿病肾病的临床效果及安全性。方法选择福州总医院干细胞治疗科收治的15例经胰背动脉、双肾动脉介入及外周静脉移植UCMSC治疗糖尿病肾病的患者为实验组,肾内科收治的15例单纯采用口服缬沙坦,皮下注射胰岛素治疗糖尿病肾病的患者为对照组。通过监测两组患者治疗前及治疗后3个月的血压、血糖、C肽值以及肾功能指标的变化情况来分析比较两组患者的治疗效果。采用配对样本t检验分别对实验组治疗前、后及对照组治疗前、后各项指标的差异进行统计分析比较,采用两独立样本t检验对实验组、对照组治疗前、后各项指标的差值进行统计分析比较。结果两组患者各项监测指标治疗后均较治疗前有所下降,差异均有统计学意义(P<0.05)。对两组患者治疗前及治疗后3个月各项指标差值进行比较,实验组、对照组患者舒张压、尿素氮、血清肌酐、24 h尿白蛋白定量治疗前后差值分别为[(14.6±3.68)mm Hg,(12.1±2.49)mm Hg,t=2.208,P=0.037],[(1.97±0.77)mmol/L,(1.04±0.32)mmol/L,t=4.261,P=0.000],[(57.6±14.08)μmol/L,(39.5±14.61)μmol/L,t=3.448,P=0.002],[(1.48±0.45)g/d,(0.74±0.35)g/d,t=5.017,P=0.000],差异有统计学意义(P<0.05)。结论经胰背动脉、双肾动脉介入及外周静脉移植UCMSC治疗糖尿病肾病安全有效,在改善舒张压、肾功能方面的临床疗效优于单纯控制血压、血糖等常规方法治疗糖尿病肾病。

Objective To probe into the clinical effect and safety of umbilical cord mesenchymal stem cell （UCMSC） transplantation on treatment of diabetic nephropathy. Methods Thirty patients with diabetic nephropathy in Fuzhou General Hospital were included. Fifteen patients in the experimental group received UCMSC transplantation via dorsal pancreatic artery, double renal arteries and peripheral vein; 15 patients who were treated only with oral valsartan and subcutaneous insulin served as control. Blood pressure, blood glucose, C protein and renal function indexes before and 3 months after the treatment were compared. We used paired-sample t test to analyze the difference of each index and independent-sample t test to analyze the difference before and after the treatment in each group. Results Blood pressure, blood glucose, and C protein decreased while renal function increased in both groups, the difference was statistically significant （P 〈 0.05）. The mean differences of DBP, BUN, SCr and 24h-UAE before and 3 months after the treatment in the experimental group and the control group were [ （14.6 ± 3.68） mmHg, （12.1 ± 2.49） mmHg, t= 2.208, P = 0.037], [（1.97 ± 0.77） mmol/L, （1.04 ± 0.32） mmol/L, t = 4.261, P = 0.000], [ （57.6 ± 14.08） μmol/L, （39.5 ± 14.61 ） μmol/L, t = 3.448, P = 0.002], and [ （ 1.48 ± 0.45） g/d, （0.74 ± 0.35） g/d, t = 5.017, P = 0.000] respectively. Conclusions It is safe and effective to infuse UCMSC through dorsal pancreatic artery, double renal arteries and peripheral vene to treat diabetic nephropathy and UCMSC is more effective than the conventional method in controlling DBP and improving renal function.