骨髓动员后自体骨髓血干细胞移植治疗糖尿病下肢血管病变疗效观察

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1、骨髓动员后自体骨髓血干细胞移植治疗糖尿病下肢血管病变疗效观察【摘要】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

2、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

3、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。【关键词】骨髓动员;自体骨髓血;干细胞移植;10糖尿病;下肢血管病变TheoberservationofdiabeticvascularlesionoflowerlimbstreatedwithbodymarrowbloodstemcelltransplantafterbonemarrowmobilizationCUIFeng-qin,TANZeng-huan,HELi-ming,etal.EndocrineSection

4、,HandanCenterHospitalHebei056001,China【Abstract】ObjectiveToobservethetherapeuticefficacyofdiabeticvascularlesionoflowerlimbsforthetreatmentofbodymarrowbloodstemcelltransplantstimulatedbybonemarrowmobilization.Methods18casesofpatientswithdistaloutflowa

5、rterystenosisweretreatedbythetherapyofbodymarrowbloodstemcelltransplant.Thepatients,15casesofmaleand3casesoffemale,werebetweentheageof52to76,withanaverageage66.2years.Thecourseofdiseaseswasdifferentfrom4to22years,withanaveragedurationof14.6years.There

6、were33affectedlimbsamongthe18cases.Allsuffererswerereceivedrecombinanthumangranulocytecolonystimulatingfactor150~300μg/dbyhypodermic10injection.TheWBCcourtduringthedaybeforeoperationwas30.0×109/L,whichwasnomorethan50.0×109/L.Thenthesuffererswereunderl

7、ocalanaesthesiainrigoroussterilecondition.Almost200mlbonemarrowbloodwasabstractedfromspinailiacaposteriorsuperior.Afterthat,40~50mlbodymarrowbloodstemcellsuspensionwaspurifiedatclass100cleanroombyusingdensitygradientcentrifugationmethod.Afterepidurala

8、nesthesiaortotalintravenousanaesthesia,thesuspensionwasinjectedintramuscularlyintheaffectedlegaccordingtothedirectionthebloodvessel.ResultThreemonthslater,responserateofthe33numbandcoldlimbswas100%.Theremissionratesofpainandintermittentlimpwer