自体外周血干细胞移植治疗糖尿病足  

Autologous peripheral blood stem cell transplantation for treatment of diabetic foot

作　　者：张雷[1] 楚同彬[1] 王新建[1] 

机构地区：[1]大连医科大学附属第二医院北院中西医结合科,辽宁省大连市116033

出　　处：《中国组织工程研究与临床康复》2010年第19期3589-3592,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：糖尿病下肢血管病变与糖尿病足的传统治疗方法主要有药物、介入或手术治疗。严重的往往需要截肢治疗,显著影响了患者的生活质量。治疗性血管生成是近年来国内外广泛开展的一项新技术。目的：评估糖尿病足患者行自体外周血干细胞移植的疗效。方法：选择大连医科大学附属第二医院北院综合治疗科收治的接受降糖药物和改善微循环扩血管药物治疗效果不佳的糖尿病足患者30例,男16例,女14例;年龄46~72岁;其中双下肢病变14例,单肢病变16例,患足共计44例。糖尿病病程3~7年不等;其中有5例在外院建议截肢。全部患者均通过自体外周细胞动员,达到标准后,采集自体干细胞悬液,在患足同侧小腿肌肉局部注射。在外周血干细胞移植的同时给予E1.丁格地尔和刺五加等药物治疗,足部溃疡定期换药及清创治疗。移植成功后,观察经皮氧分压和皮温足部感觉,溃疡及坏疽情况,不良反应等。结果与结论：纳入糖尿病足患者30例,其中1例同并心脑血管疾病在随访期病故,其余29例患者进入结果分析。对所有病例行6个月定期观察和随访,发现外周血干细胞移植后7~14d,30例患者（44足）疼痛明显缓解,患足皮氧分压和皮温显著上升,足部感觉明显增强。1~6周后,感染得到控制,12~16周,29例患者溃疡处坏疽明显好转,出现新生肉芽组织。6个月后4例完全愈合。15例患者在血细胞动员时感骨骼和肌肉酸痛,移植后5d患者均感觉足部及小腿肌肉轻度胀痛。提示自体外周血干细胞移植能有效增加患者下肢血流,促进溃疡愈合,可使一部分患者有免除截肢和改善生活质量的效果。BACKGROUND：Conventional therapeutic methods for vascular lesion in the lower limb following diabetes and for diabetic foot include drug,intervention or surgery.If severe,amputation is needed,which significantly affects quality of life of patients.Therapeutic vascularization is a new technique that has widely developed all over the world.OBJECTIVE：To evaluate the efficacy of autologous peripheral blood stem cell transplantation for treating patients with diabetic foot.METHODS：A total of 30 patients with diabetic foot,who had been treated with medicines of reducing blood sugar and of improving microcirculation and expanding blood vessels,resulting in a poor outcome,were included at the Department of Combined Therapy,Second Affiliated Hospital（North District）,Dalian Medical University.There were 16 males and 14 females,aged 46-72 years,including 14 cases of lesion in both lower extremities and 16 cases of lesion in single extremity.A total of 44 cases had affected feet.The courses of diabetes were from 3-7 years.Of them,5 cases were advised to receive amputation in other hospitals.All patients underwent autologous peripheral cell mobilization.When reached standards,autologous stem cell suspension was collected.Local injection was performed in ipsilateral leg muscles of affected feet.At the same time,E1 Dingle and manyprickle acanthopanax root were infused into patients.Ulceration dressings was regularly replaced and debrided.After successful transplantation,the temperature of skin,the feeling of foot,ulceration and gangrene,adverse effects were observed.RESULTS AND CONCLUSION：Among initial 30 patients with diabetic foot,1 patient died of cardio-cerebrovascular disease during follow-up,so 29 patients were included in the final analysis.All cases were followed up for 6 months.At 7-14 days following peripheral blood stem cell transplantation,pain significantly relieved in 30 patients（44 feet）.Percutaneous oxygen pressure and skin temperature were obviously increased in injured feet.Feeling in feet was m

关 键 词：糖尿病足 自体外周血 干细胞 移植 自体外周细胞 动员 

分 类 号：R394.2[医药卫生—医学遗传学]