外周血干细胞联合外泌体治疗糖尿病足溃疡创面疗效观察

Therapeutic Effect of Peripheral Blood Stem Cells Combined with Exosomes on Diabetic Foot Ulcer Wounds

目的:探究自体PBSCs联合SC-Exos对糖尿病足溃疡(Diabetic foot ulcer,DFU)创面的治疗效果。方法:将60例溃疡患足随机分为对照组、SC-Exos外敷组(治疗组A)、PBSCs注射组(治疗组B)、PBSCs联合SC-Exos组(治疗组C)各15足,在常规治疗(对照组)基础上,分别予以SC-Exos外敷或/和PBSCs创面周边注射,2周后第2次给药,并于第1次给药后第4、8和12周观察患者溃疡创面面积变化,肉芽形态评分,患足疼痛、冷感和跛行症状评分,足背动脉收缩期峰值流速(Peak systolic velocity,PSV)和血管内径及总有效率。结果:治疗后,四组患足溃疡创面面积变化,肉芽形态评分,患足疼痛、冷感和跛行症状评分,足背动脉PSV和血管内径较治疗前均有显著改善,各指标组间两两比较,治疗组A与治疗组B比较差异无统计学意义(P>0.05),其余各组间比较差异均有统计学意义(P<0.05),其中,治疗组C各指标结果明显优于其他各组(P<0.05)。治疗12周后,对照组、治疗组A、治疗组B三组行两两比较,差异无统计学意义(P>0.05),治疗组C总有效率明显高于其他各组(P<0.05)。结论:PBSCs、SC-Exos和两者联合治疗均能促进DFU创面愈合,改善患足症状和血液循环,PBSCs和SC-Exos联合应用的疗效比单一应用更好。

Objective To investigate the therapeutic effect of autologous PBSCs combined with SC-Exos on diabetic foot ulcer(DFU)wound.Methods Sixty patients with ulcerated feet were randomly divided into control group,SC-Exos external application group(treatment group A),PBSCs injection group(treatment group B),and PBSCs combined with SC-Exos group(treatment group C)with 15 feet in each group.On the basis of conventional treatment(control group),SC-Exos external application or/and PBSCs peripheral injection were given respectively,and the second dose was given 2 weeks later.The ulcer wound area,granulation morphology score,foot pain,cold sensation and lameness score,peak systolic velocity(PSV),vessel diameter and total effective rate of the patients were observed at 4,8 and 12 weeks after the first dose.Results After treatment,the wound area changes,granulation shape scores,pain,cold feeling and lameness scores of the affected foot,PSV and vessel diameter of the dorsal foot artery in the four groups were significantly improved compared with before treatment.Pairwise comparison of all indicators among groups showed no statistical significance between treatment group A and treatment group B(P>0.05).There were statistically significant differences among the other groups(P<0.05),and the results of C indexes in the treatment group were significantly better than those in the other groups(P<0.05).After 12 weeks of treatment,the control group,treatment group A and treatment group B were compared pair-to-pair,and the difference was not statistically significant(P>0.05).The total effective rate of treatment group C was significantly higher than that of other groups(P<0.05).Conclusion PBSCs,SC-Exos and their combined intervention can promote wound healing in patients with severe diabetic foot ulcer(DFU),improve symptoms and blood flow of the affected foot,and the combined application of PBSCs and SC-Exos is better than the single application.