间充质干细胞全身输注联合局部介入治疗系统性红斑狼疮股骨头缺血性坏死临床分析

Intravenous infusion and local arterial perfusion of mesenchymal stem cells on osteonecrosis of femoral head in patients with systemic lupus erythematosus:a clinical analysis

目的观察间充质干细胞(MSCs)全身输注联合局部介入治疗系统性红斑狼疮(SLE)患者股骨头缺血性坏死(ONFH)的临床疗效。方法选择4例SLE股骨头坏死患者,经皮-股动脉穿刺经旋股内动脉灌注MSCs悬液,同时静脉输注MSCs。间隔2周再进行第2次治疗。评估治疗前及治疗后半年SLE疾病活动性、疼痛、行走距离、关节功能、磁共振成像(MRI)评价等指标。结果短期随访(6个月),4例疼痛改善及关节活动度均改善,1例影像学无改善。随访终点(3年),治疗组4例中1例发生股骨头塌陷。结论 MSCs灌注治疗股骨头坏死安全,无不良反应,短期内有效率高,长期随访可降低股骨头塌陷发生率,本研究为小样本观察,临床可进一步扩大病例数,以期作为一种新技术进行广泛开展。

Objective To investigate the clinical effects of intravenous infusion and local arterial perfusion of mesenchymal stem cells （MSCs） on osteonecrosis of femoral head（ONFH） in patients with systemic lupus erythematosus（SLE）. Methods Four SLE patients with ONFH were randomly included in the study. MSCs suspension was perfused via percutaneous-femoral artery puncture and medial femoral circumflex artery, with intravenous infusion of MSCs. The second treatment was performed after the 2 weeks interval. The SLE disease activity, pain, walking distance, joint function, MRI evaluation indicators at the baseline and at half a year after the treatment were evaluated. Results At the short-term follow-up （6 months）, the pain and joint activity were improved in 4 cases, and the imaging findings were not improved in 1 case. At the end of long-term follow-up （3 years）, 1 case of femoral head collapse was found in the study group. Conclusion MSCs infusion in the treatment of ONFH is safe, with noadverse reactions and high short-term effective rate. Long-term follow-up can reduce the incidence of femoral head collapse. Although this study is for small sample observation, more number of cases may be further expanded clinically. It can be used as a new technology widely.