自体骨髓干细胞移植治疗血栓闭塞性脉管炎  

Autologous Bone-Marrow Cell Transplantation for Treatment of Thromboangitis Obliterans

作　　者：李学锋[1] 沈振亚[2] 谷涌泉[1] 张建[1] 俞恒锡[1] 郭连瑞[1] 齐立行[1] 崔世军[1] 吴英峰[1] 佟铸[1] 汪忠镐[1] 

机构地区：[1]首都医科大学宣武医院血管外科,北京100053 [2]苏州大学第一附属医院心外科,江苏苏州215006

出　　处：《中国普外基础与临床杂志》2010年第7期656-659,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨自体骨髓干细胞移植治疗血栓闭塞性脉管炎(TAO)的疗效及安全性。方法对13例TAO患者(17条患肢)行自体骨髓单个核细胞(BM-MNC)肌注移植术,采用主观指标包括患肢疼痛和冷感以及客观指标包括踝肱指数(ABI)、经皮氧分压(TcPO2)和足部溃疡变化进行疗效评价。结果移植治疗2个月后疼痛缓解者15条,冷感缓解者16条。移植前ABI为0.37±0.06,移植治疗后2个月为0.50±0.17(P<0.05),ABI改善者9条。TcPO2移植治疗前为(24.59±3.36)mmHg(1mmHg=0.133kPa),移植治疗后2个月为(35.00±10.44)mmHg(P<0.05),TcPO2改善14条。溃疡改善者7条。经4～18个月(平均8个月)随访,患者主观症状改善者13条;客观指标ABI为0.45±0.14,与移植治疗前和移植治疗后2个月比较,差异均无统计学意义(P>0.05);TcPO2为(33.24±10.43)mmHg,与移植治疗前和移植治疗后2个月比较,差异有统计学意义(P<0.05),改善率为70.6%(12/17)。溃疡愈合者5条,有2例2条患肢的溃疡伴疼痛无缓解,无死亡及高位截肢者。所有患者经常规检查未发现视网膜增生、恶性肿瘤、心肌梗塞、脑梗塞、血管瘤形成等并发症。结论自体骨髓干细胞移植是一种安全、有效的治疗TAO手段,改善患肢症状及促进溃疡愈合。Objective To investigate the effect and safety of autologous bone marrow-mononuclear cell （BM-MNC） transplantation on ischemic limb of patients with thromboangiitis obliterans （TAO）.Methods Thirteen patients with TAO underwent transplantation of autologous BM-MNC into ischemic muscles of 17 lower limbs.A series of subjective indexes （improvement of pain and cold sensation） and objective indexes including increase of ankle brachial index （ABI）,transcutaneous oxygen pressure （TcPO2）,and improvement of foot skin ulcer were used to evaluate the effects.Results The outcomes were evaluated after 2 months of transplantation.The pain relief and improvement of cold feeling were in 15 limbs and 16 limbs,respectively.Before transplantation and 2 months after transplantation,ABI was 0.37±0.06 and 0.50±0.17,respectively （P〈0.05）,and TcPO2 of the ischemic legs were （24.59±3.36） mm Hg （1 mm Hg=0.133 kPa） and （35.00±10.44） mm Hg,respectively （P〈0.05）.ABI increased in 9 limbs.TcPO2 elevated in 14 limbs.Skin ulcer improved in 7 limbs.Thirteen patients were followed up from 4 to 18 months （average 8 months）,the patients’ symptoms improved in 13 limbs.ABI was 0.45±0.14,which wasn’t different from those before transplantation and 2 months after transplantation （P〈0.05）.TcPO2 was （33.24±10.43） mm Hg,which was different from those before transplantation and 2 months after transplantation （P〈0.05） and was elevated in 12 limbs.Skin ulcer healing was in 5 limbs.The ischemic symptoms in 2 patients were not relieved.There was no mortality and high level amputation.The following complications,such as proliferative retinopathy,malignant tumor,myocardial infarction,stroke or hemangioma,were not found in all patients.Conclusion In patients with TAO,intramuscular transplantation of autologous BM-MNC is a safe and effective method,and may improve symptoms and accelerate the healing of skin ulcer.

关 键 词：血栓闭塞性脉管炎 自体骨髓单个核细胞 皮肤溃疡 踝肱指数 经皮氧分压 

分 类 号：R543[医药卫生—心血管疾病]