论文部分内容阅读
目的观察骨髓动员刺激后的自体骨髓血干细胞移植治疗糖尿病下肢血管病变的临床疗效。方法应用骨髓动员后的自体骨髓血干细胞移植治疗远端流出道狭窄的糖尿病下肢血管病变患者共18例,男15例,女3例,年龄52～76岁,平均66.2岁,糖尿病病程4～22年,平均14.6年。18例患者中共有患肢33条。所有患者均予重组人粒细胞集落刺激因子150～300μg/d皮下注射,使手术日WBC达30.0×109/L(不超过50.0×109/L)。然后在严格无菌操作下,行局部麻醉,自髂后上棘抽取骨髓血200ml左右,在百级操作间,用密度梯度离心法分离提纯出自体骨髓干细胞悬液40～50ml,在硬膜外麻醉或静脉全麻下,于患肢小腿沿血管走行方向自上而下予以肌肉注射。结果观察3个月,33条患肢麻木、冷凉缓解率为100%;疼痛缓解率为89.7%;间歇性跛行缓解率为47.1%;行走间距延长率为52.9%;溃疡愈合率为66.7%;坏疽好转率为50%;有2例2条患肢坏疽截肢平面降低;踝肱动脉指数(ABI)改善率75.8%。本组病例未发现其他并发症及不良反应。结论骨髓动员刺激后的自体骨髓血干细胞移植治疗糖尿病下肢血管病变方法简便、安全、有效。
Objective To observe the clinical efficacy of autologous bone marrow stem cells transplantation in the treatment of diabetic lower extremity vascular diseases after mobilization of bone marrow. Methods A total of 18 patients with diabetic lower extremity vascular disease with bone marrow mobilization after autologous bone marrow stem cell transplantation were enrolled. There were 15 males and 3 females, aged 52-76 years with an average of 66.2 years old and with diabetes course ranging from 4 to 22 Year, an average of 14.6 years. There were 33 limbs in 18 patients. All patients were subcutaneously injected with recombinant human granulocyte colony-stimulating factor 150 ~ 300μg / d, so that the WBC of operation day was 30.0 × 109 / L (no more than 50.0 × 109 / L). Then under strict aseptic operation, local anesthesia, bone marrow blood from the posterior superior iliac spine to extract about 200ml, in the 100 operating room, using density gradient centrifugation isolated and purified from bone marrow stem cell suspension 40 ~ 50ml, in the epidural Anesthesia or intravenous anesthesia, in the limb leg along the blood vessels running direction from top to bottom to be intramuscularly injected. Results 3 months, 33 limb numbness, cold relief rate was 100%; pain relief rate was 89.7%; intermittent claudication rate was 47.1%; walking distance extension rate was 52.9%; ulcer healing rate was 66.7% ; Gangrene improvement rate was 50%; 2 cases of gangrene gangrene amputation plane reduced; ankle brachial artery index (ABI) improvement rate of 75.8%. This group of patients found no other complications and adverse reactions. Conclusion The method of bone marrow mobilization stimulated autologous bone marrow stem cell transplantation in the treatment of diabetic lower limb vascular disease is simple, safe and effective.