自体骨髓衍生单核细胞植入治疗血管生成对硬皮病严重肢体缺血的影响

The Effect of Autologous Bone Marrow-derived Monocyte Implantation for Therapeutic Angiogenesis on Severe Limb Ischemia in Scleroderma

目的:探讨自体骨髓单个核细胞(bone marrow mononuclear cells,BM-MNC)植入治疗血管生成对硬皮病严重肢体缺血的影响。方法:收集我院2018年6月-2021年1月收治的腔隙性脑梗死(cerebral lacunar infarction,CLI)伴系统性硬皮病患者(systemic sclerosis,SSc)患者60例,根据患者治疗意愿区分为研究组(接受BM-MNC治疗,30例)与对照组(接受常规保守治疗,30例),对比两组患者干预后疼痛度、跛行距离、踝肱指数(ankle brachial index,ABI)、经皮氧分压以及不良反应的发生情况。结果:治疗前两组患者的VAS评分、跛行距离组间差异无统计学意义(P>0.05),治疗1个月时两组患者的VAS评分均较治疗前均降低,跛行距离均延长,组间差异明显(P<0.05),治疗6个月时比较显示研究组VAS评分明显低于对照组,跛行距离明显高于对照组(P<0.05)。治疗前两组患者的ABI、经皮氧分压差异无统计学意义(P>0.05),治疗1个月时两组患者的ABI、经皮氧分压均较治疗前升高(P<0.05),组间差异明显(P<0.05),治疗6个月时比较显示研究组ABI和经皮氧分压明显高于对照组(P<0.05)。研究组治疗6个月期间出现中风1例,肝肾功异常2例,不良反应总发生率为6.00%,对照组治疗6个月期间出现非致命性心肌梗死1例,中风1例,肝肾功能异常3例,不良反应总发生率10.00%,两组间不良反应发生率比较差异无统计学意义(P>0.05)。结论:对CLI伴发SSc患者实施自体骨髓衍生单核细胞植入治疗可行性较好,能够显著改善患者的肢体功能及患肢血运,同时治疗安全性较高,值得临床推广应用。

Objective: To investigate the effect of autologous bone marrow-derived monocytes implantation on severe limb ischemia in patients with scleroderma. Methods: 60 cases of CLI patients with SSc in our hospital from June 2018 to January 2021 were collected and divided into study group(30 cases received BM-MNC treatment) and control group(30 cases received conventional conservative treatment) according to the treatment willingness of patients. The pain degree, claudication distance, ankle brachial index(ABI),transcutaneous oxygen partial pressure and adverse reactions of the two groups after intervention were compared. Results: Before treatment, there was no significant difference in the VAS score and claudication distance between the two groups of patients(P>0.05). At 1 month of treatment, the VAS scores of the two groups were lower than before treatment, and the claudication distance was prolonged.There was a difference between the groups(P<0.05), the comparison after 6 months of treatment showed that the VAS score of the study group was significantly lower than that of the control group, and the claudication distance was significantly higher than that of the control group(P<0.05). Before treatment, there was no significant difference in ABI and transcutaneous oxygen partial pressure between the two groups of patients(P>0.05). After 1 month of treatment, the ABI and transcutaneous oxygen partial pressure of the two groups were both higher than before treatment(P<0.05), the difference between the groups was significant(P<0.05). The comparison at 6 months of treatment showed that the ABI and transcutaneous oxygen partial pressure in the study group were significantly higher than those in the control group(P<0.05). During 6 months of treatment in the study group, there was 1 case of stroke and 2 cases of abnormal liver and kidney function. The total incidence of adverse reactions was 6.00 %. During the 6 months of treatment in the control group, 1 case of non-fatal myocardial infarction, 1 case of stroke, liver and kidney 3 cases of abnormal work, the total incidence of adverse reactions was 10.00 %,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: The feasibility of autologous bone marrow-derived monocytes implantation in patients with CLI associated with SSc is good, which can significantly improve the limb function and blood supply of patients, and has high safety, which is worthy of clinical application.