自体骨髓干细胞移植治疗下肢动脉硬化闭塞症的疗效分析  

作　　者：张雷[1] 陈涛[1] 王琨[1] 仝现州[1] 

机构地区：[1]郑州人民医院普外二科,河南450003

出　　处：《当代医学》2016年第7期66-67,共2页Contemporary Medicine

摘　　要：目的探讨自体骨髓干细胞移植(ABMT)治疗下肢动脉硬化闭塞症的效果分析。方法 45例下肢动脉硬化闭塞症患者,术前均给予皮下注射粒细胞集落刺激因子(granulocyte-colony stimulating factor,G-CSF)进行骨髓动员,抽取约200 mL骨髓血,经过分离,提纯后提取骨髓干细胞,采用多点注射在下肢缺血部位的肌肉内,进行骨髓干细胞移植。结果移植治疗6个月后疼痛、麻木、冷感缓解37例,改善率为82.22%。45例缺血评分由术前(9.83±3.08)分降至(3.67±1.00)分,差异有统计学意义(P<0.05),与术前比较,踝肱指数(ABI)明显升高(P<0.05)。8例伴有溃疡者,溃疡愈合或面积逐渐减小。在4例足趾严重坏疽患者中,其中2例经手术切除坏疽足趾后,愈合良好;1例疼痛症状消失,坏疽组织脱落后痊愈;1例于膝关节平面下行截肢手术,术后恢复良好。结论 ABMT是一种安全、有效的治疗下肢动脉硬化闭塞症的方法。虽然缺乏远期的随访结果,但对于不适于行介入及动脉旁路移植治疗且药物治疗效果差的患者,或者年老体弱或伴发其他疾病不能接受手术的患者,是一种不错的治疗方法。Objective To explore the effect of autologous bone marrow stem cell transplantation in the treatment of arteriosclerosis obliterans of the lower extremities. Methods 45 patients with arteriosclerosis obliterans of the lower extremities,who were injected G-CSF pre-operation for bone marrow mobilization, were abstracted about 200 mL of autologous bone marrow blood. The blood were extracted bone marrow stem cells, which were implemented ABMT through multi-point injection within the ischemia muscle, after separation, purification, etc. Results Six months after transplantation, the symptoms of pain, paresis, and coldness were improved by 82.22%. Ischemia score was improved from preoperative （9.63±3.08） points to postoperative （3.67±1.00） points in 45 cases, and the difference was statistically significant （P〈0.05）; compared with those before transplantation, ABI was significantly higher after treatment （P〈0.05） The ulcers of 8 patients healed up or reduced in size. Among the 4 patients with toesgangrene, 2 patients had a good wound healing after the gang renous toes resection, 1 patient got rid of the pain, the gangrenous tissue began to exfoliate and was crued, 1 patient was subjected to a below-knee amputation. Conclusion ABMT is a simple, safe and effective method for arteriosclerosis obliterans of the lower extremities. Though the results of long-term follow-up are not supported enough, it is still a good method for the patients who cann not receive interventional therapy, artery bypass grafting and drug therapy poorly or for the senile patients, who are physically weak or with other diseases, cannot receive operation.

关 键 词：自体骨髓干细胞移植 下肢动脉硬化闭塞症 骨髓动员 血管生成 

分 类 号：R654.4[医药卫生—外科学]