自体外周造血干细胞移植治疗下肢缺血性血管病临床观察(附51例报告)

摘要

Objective To observe the clinical efficacy of autologous peripheral blood stem cels(APBSC)transplantation with ischemic lower extremity disorder. Methods From August 2004 to May 2012, 51 patients with 28 case of various lower extremity ischemic disorder and 23case of diabetic foot received rhG-CSF 600ug/d by hypodemic injection for 4 days to molilize stem cels. On the fifth day,PBSC were colected with MCS+blood cel separator and prepared into stem cel suspension for limb transplantation by 3cm×3cm distance. The number of mononuclear cels is (306.3-670.6) ×109/L. Results After treatment for 6 months, the pain score and cold sensation of affected limbs score were improved .There were significant differences in intermitten claudication of lower limbs score, transcutaneous oxygen partial pressure and skin temperature after 3 or 6 months treatment (P<0.05). There was no significant difference in ankiel brachial index after treatment. Improvement of foot ulcer in 10 cases. DSA or CTA scores were performed in 23 patients, there was formation of new colateral vessels. Conclusion The clinical symptoms and objective indexes of lower extremity ischemic disorder were improved after APBSC transplantation. APBSC transplantation might be a safe and effective method for lower extremity ischemic disorder.%　　目的观察自体外周造血干细胞移植治疗下肢缺血性血管病的疗效.方法2004年8月-2012年5月住院下肢缺血性血管病51例,其中下肢闭塞性动脉硬化症25例,糖尿病足23例,血栓闭塞性脉管炎3例,发生足部溃疡或坏疽22例.双下肢病变38例,单肢病变13例,共移植89条下肢.全部患者均给予rhG-CSF 600ug/d皮下注射,行BPSC动员4天,第5天用血细胞分离机采集单个核细胞(MNC)悬液总量80-120ml,MNC数量(306.3-670.6)×109/L.将MNC悬液按3cm×3cm距离行双下肢肌肉内注射,每点0.3-0.5ml.结果移植后6个月疼痛评分及肢冷感评分明显改善,间歇性跛行、经皮氧分压、皮肤温度移植后3、6个月比较差异均有显著性意义(P<0.05).移植后踝肱指数升降不一,10例足部溃疡好转,23例DSA或CTA结果显示新侧支血管形成明显增加.结论 APBSC移植可改善缺血性下肢血管病的临床症状及客观指标,是缺血性下肢血管病治疗的一种有效方法.