骨髓动员后自体骨髓源单个核细胞移植治疗血栓闭塞性脉管炎  

Autologous bone marrow-mononuclear cell transplantation after the bone marrow stimulation in thetreatment of thromboangiitis obliterans

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

机构地区：[1]大学附属第一医院心血管外科,苏州215006 [2]首都医科大学宣武医院血管外科

出　　处：《中国综合临床》2011年第7期716-720,共5页Clinical Medicine of China

摘　　要：目的探讨骨髓动员后自体骨髓单个核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12例（15条患肢）下肢严重缺血的TAO患者先使用粒细胞集落刺激因子（GCSF）刺激骨髓3—5d后，抽取骨髓血150～200ml，经分离纯化后采用下肢肌肉注射法行自体骨髓单个核细胞（BM—MNC）移植；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2个月后疼痛缓解率为86．7％（13／15），冷感缓解率为93．3％（14／15）。移植前ABI为0．38±0．05，移植治疗后2个月为0．61±0．14（t=一6．34，P〈0．05），ABI改善率66．7％（10／15）。TcPO：移植前为（27．47±2．85）mmHg，移植治疗后2个月为（43．53±8．38）mmHg（t=一7．03，P〈0．05），TcP02改善率为93．3％（14／15）。9条肢体溃疡改善8条。经平均10个月随访，患者主观症状改善率为80．0％（12／15）；客观指标ABI为0．57±0．13（与移植前比较，t=一5．33，P〈0．05），TcP02为（42．07±7．81）mmHg（与移植前比较，t=一7．80，P〈0．05），溃疡愈合率达66．7％（6／9），有2例2条患肢溃疡无改善，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、心肌梗死、脑梗死、血管瘤形成等并发症。结论骨髓动员后自体骨髓单个核细胞移植具有抽取骨髓血少、单个核细胞量多和安全性高等优点，可能是一种新而有效的治疗TAO手段，尤其对改善患肢症状及促进溃疡的愈合效果明显。Objective To investigate the effect and safety of autologous bone marrow-mononuclear cell （BM-MNC） transplantation after the bone marrow stimulation in patients with thromboangiitis obliterans （TAO）. Methods The bone marrows of 12 patients were stimulated by an injection of the recombinant human granulocyte-maerophage colony-stimulatory factor （GCSF） for 3 -5 days. 150 -200 ml bone marrow was drown from the iliae spine and the autologous BM-MNC were obtained in each patients. Fifteen lower limbs of 12 patients received implantation of the autologous BM-MNC by an intramuscular injection. A series of subjective indexes （including improvement of pain and cold sensation） and objective indexes [ including increase of ankle braehial index （ABI） ,transcutaneous oxygen pressure （TePO2 ） 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 rate and the cold feeling improvement rate were 86.7% （ 13/15 ） and 93.3% （ 14/15 ） respectively. The ABI were O. 38 ± 0. 05 vs. 0.61 ± 0. 14 （ P 〈 0.05 ） before transplantation and 2 months after transplantation respectively,increased in 66.7% （10/15） limbs. The TcPO2 of the ischemie legs increased from （27.47±2.85 ）mm Hg to （43.53 ± 8.38 ） mm Hg （ t = - 7. 03,P 〈 0.05 ） after the transplantation, and the improvement rate of TcPO2 was 93.3% （ 14/15 ）. Skin ulcers in improved in 8/9 limbs. Twelve patients were followed up for an average period of 10 months. The patients＇ symptoms improved in 80.0% （12/15） limbs, as to the objective index the ABI was 0.57± 0. 13, TcPO2 was （42.07 ± 7.81 ）mm Hg, which improved significantly compared to before treatment （ t = - 5.33, - 7.80, Ps 〈 0.05 ）. Skin ulcer healing rate was 66.7% （6/9）. The ischemic symptoms in 2 patients were not relieved. There was no mortality and high level amputation in all subjects. The complications, such as proliferative retinopathy, ma

关 键 词：血栓闭塞性脉管炎 粒细胞集落刺激因子 骨髓单个核细胞 踝肱指数 经皮氧 分压 皮肤溃疡 

分 类 号：R654.4[医药卫生—外科学]