干细胞源性血管依从性与缺血态组织二次血流的重建  

Compliance of ischemic tissue to stem cells-derived vessels for secondary revascularization

作　　者：何晓明[1] 杨镛[1] 万嘉[1] 

机构地区：[1]昆明医学院第四附属医院(云南省第二人民医院)云南省血管外科中心干细胞治疗研究室,云南省昆明市650021

出　　处：《中国组织工程研究》2014年第45期7333-7336,共4页Chinese Journal of Tissue Engineering Research

基　　金：云南省自然科学基金(2008CD205;2010ZC219);云南省学术与技术带头人后备人才基金(2008PY004)~~

摘　　要：背景:探寻血管腔内修复术后二次肢体血流重建的方法也是该学科领域中最迫切的研究课题之一。目的:探讨自体干细胞移植衍生的新生血管主导和完善缺血态组织二次血流重建效应的生物学机制。方法:下肢动脉缺血性疾病患者42例,第1次血流重建方法选择血管腔内修复术,第2次血流重建方法选择自体外周血干细胞移植,于首次术后3个月实施,自体外周血干细胞移植后随访4年。结果与结论:自体外周血干细胞移植后自觉小腿区静息痛明显减轻,间隙性跛行距离显著延长,保肢率100%;患者肢体局部血流量变效应指标皮温指数为1.6±0.3,经皮氧分压为(5.00±1.26)k Pa,踝肱指数为0.9±0.2,光电容积微血流态指数为0.8±0.1,血氧饱和度为(79.4±20.4)%,数字减影血管造影评分为1.3±0.2,各项指标均较移植前有显著改善。移植后下肢局部血流量变效应指标与肢体局部症状变化指标呈正相关(0.6<r<0.7,P<0.05)。结果可见干细胞源性新生血管量及其供给组织的持久有效的血液灌注量是主导和完善缺血态组织二次血流重建效应的主要生物学机制。BACKGROUND：To explore the methods for secondary limb revascularization after endovascular repair is one of the most urgent research topics. OBJECTIVE：To investigate the biological mechanism about the transplantation of autologous peripheral blood stem cel s to lead and perfect the effect of ischemic tissue for secondary revascularization. METHODS：Forty-two patients with critical low limb ischemia were selected and treated with endovascular repair as first revascularization and transplantation of autologous peripheral blood stem cel s as secondary revascularization. The secondary revascularization was carried out at 3 months after the first blood flow remodeling. The patients receiving secondary revascularization were fol owed for 4 years. RESULTS AND CONCLUSION：After transplantation of autologous peripheral blood stem cel s, the patients complained that the rest pain of the lower leg was relieved obviously and intermittent claudication distance was significantly lengthened. Limb salvage rate was 100%. Skin temperature index was 1.6±0.3, transcutaneous oxygen pressure was （5.00±1.26） kPa, ankle-brachium index was 0.9±0.2, photoplethysmograpy index was 0.8±0.1, saturation of blood oxygen was （79.4±20.4）%, and digital subtraction angiography score was （1.3±0.2） 〈br〉 points. After transplantation, local blood flow indicators of the low limbs were positively correlated to local symptom indicators of the limbs （0.6〈r〈0.7, P〈0.05）. These results strongly suggest that the stem cel s-derived neovascularization can offer effective and permanent blood flow perfusions to the ischemic tissue, and this biological effect play an important role in secondary revascularization of the ischemic tissue.

关 键 词：干细胞 移植 下肢动脉缺血 干细胞临床应用 自体外周血干细胞 血流重建 血管新生 云南省自然科学基金 

分 类 号：R394.2[医药卫生—医学遗传学]