自体骨髓干细胞移植治疗下肢缺血性疾病的疗效观察  

Curative Effect of Autologous Bone Marrow Stem Cell Transplantation in the Treatment of Ischemic Disease of Lower Limb

作　　者：任超[1] 刘小云[2] 耿德勤[1] 葛巍[1] 张伟伟[1] 李金梅[1] 万美容[2] 徐铁[3] 

机构地区：[1]徐州医学院附属医院神经内科,江苏省徐州市221002 [2]徐州医学院附属医院中心实验室,江苏省徐州市221002 [3]徐州医学院附属医院急诊科,江苏省徐州市221002

出　　处：《中国全科医学》2013年第18期2152-2156,共5页Chinese General Practice

摘　　要：目的观察自体骨髓干细胞移植治疗下肢慢性缺血性疾病的临床疗效,初步总结全程医护配合模式在治疗过程中的作用。方法我院2010-02-10收治2型糖尿病致左下肢糖尿病足(坏疽型)患者1例,2010-06-01收治下肢动脉粥样硬化并血栓形成致左下肢动脉闭塞症患者1例。均采用自体骨髓干细胞移植治疗,移植3次,移植过程中采用全程医护配合模式。随访2年观察治疗效果及不良反应。结果患者1干细胞移植治疗前,左足第四足趾坏死、溃烂,趾根和脚面连接处可见脓性分泌物,疼痛,不能行走;双下肢动脉彩超示双足背动脉粥样硬化闭塞症且双下肢股总、股深、股浅、腘动脉粥样硬化,电子计算机断层扫描血管造影(CTA)显示左足部供血血管稀疏。治疗后1个月足部疼痛减轻。治疗后3个月皮温较前升高,可感觉到微弱足背动脉搏动。治疗后6个月患者溃疡面开始出现愈合,皮温亦继续升高,色泽转红润。治疗后1年溃疡愈合面积继续增大。治疗后2年时CTA示供血血管较前有再通,仅有一小块溃疡未愈合。患者2干细胞移植治疗前,左下肢酸痛、无力,呈间歇性跛行发作,直立或行走后疼痛加剧,休息可得到部分缓解。查体见左足第四、五足趾发绀、粗糙,足背动脉搏动微弱、皮温下降;双下肢CTA示左侧股动脉远端、左腘动脉、左胫前动脉、左胫后动脉节段性管腔闭塞且左小腿动脉显影浅淡。治疗后1个月站立时疼痛减轻,足背动脉搏动增强,皮温较前升高。治疗后3个月行走距离增长,疼痛次数减少。治疗后6个月左足第四、五足趾色泽转红润。治疗后1年左足第四、五足趾光滑不再粗糙。治疗后2年CTA示供血血管较前丰富。3次移植,均未见注射局部及全身有明显不良反应发生。结论自体骨髓干细胞通过局部肌内注射法移植治疗下肢缺血性疾病是一种可行、方便、安全、有效的方法;全程医�Objective To observe the clinical efficacy and side effects on the patients with lower limb ischemic disease who been treated by autologous bone marrow stem cell transplantation and to explore the advantages of the model of team - working by doctors and nurses in the treatment process. Methods One T2DM patient admitted to our hospital on February 10, 2010 and June 1, 2010 with left lower extremity diabetic foot （ gangrene type） and with left lower peripheral arterial occlusive disease caused by extremity atherosclerosis and thrombosis respectively were both treated by autologous bone marrow stem cells transplantation for three times, and during the process the model of team - working by doctors and nurses was adopted. All the patients were followed up for two years to observe curative efficacy and adverse effect. Results For the first patient, before treatment, there were necrosis and ulceration in the fourth digit of foot and purulent secretion in the joint of toe root and upper surface of feet. The patient was painful and cannot walk. Color doppler ultrasound of double lower limbs showed atherosclerosis and occlusive disease in dorsal arteries of double feet and atherusclerosis in common femoral artery, deep femoral artery, superficial femoral artery and popliteal artery of both lower limbs. CTA showed sparse suppliers of blood in the left foot. After one - month treatment, the pain in the foot was alleviated. After three - month treatment, skin temperature increased and the beat of dorsal arteries could be felt. After six - month treatment, the ulceration began to heal, skin temperature continued to increase and its color turned into pink. After one - year treatment, the ulceration continued to heal. After two - year treatment, CTA showed better blood flow of blood suppliers and only a small area of ulceration left unhealed. For the second patient, before treatment, left lower limb was sore and weak, and limp occurred intermittently and it aggravated when standing upright and walking and partly alleviated

关 键 词：骨髓 干细胞移植 下肢缺血性疾病 

分 类 号：R658.3[医药卫生—外科学]