自体外周血干细胞局部注射联合腔内介入治疗糖尿病下肢血管病变  

Autologous peripheral blood stem cell transplantation combined with percutaneous transluminal angioplasty for diabetic lower extremity vascular disease

作　　者：顾露[1] 张姝梅[1] 于翔[1] 杨毅[2] 

机构地区：[1]四川省医学科学院.四川省人民医院介入中心,四川省成都市610072 [2]四川省医学科学院.四川省人民医院内分泌科,四川省成都市610072

出　　处：《中国组织工程研究》2016年第14期2086-2091,共6页Chinese Journal of Tissue Engineering Research

基　　金：四川省卫生厅基金项目(110214);名称:自体外周血干细胞移植治疗糖尿病足的临床研究~~

摘　　要：背景:研究表明外周血干细胞具有高度分化潜能,可分化成血管内皮细胞,促进血管再生,改善侧支循环,从而达到治疗肢体缺血的目的。目的:观察糖尿病下肢血管病变患者腔内治疗结合自体外周血干细胞移植的临床效果。方法:收集2011年3月至2014年12月住院治疗的糖尿病下肢血管病变患者50例,其中25例采取腔内治疗和自体外周血干细胞移植(联合组),另外25例只采取腔内治疗(对照组)。所有患者于治疗后1,6,12个月随访,记录患肢疼痛、冷感等主观评分,测定踝肱指数、经皮氧分压、跛行距离等客观指标。结果与结论:(1)两组患者治疗后踝肱指数均明显增加,尤其是治疗后1个月时增加显著,治疗后6,12个月有所下降,但与治疗前比较差异均有显著性意义(P<0.05)。治疗后1,6,12个月时两组比较差异无显著性意义(P>0.05);(2)两组患者治疗后经皮氧分压、跛行距离也明显增加,治疗后1,6,12个月与治疗前比较差异均有显著性意义(P<0.05),治疗后1,6,12个月时联合组经皮氧分压、跛行距离高于对照组,差异有显著性意义(P<0.05);(3)治疗后12个月内患肢痛感和冷感均有不同程度改善,联合组改善更明显;(4)外周血干细胞采集过程中出现低钙血症3例,移植后出现发热2例,局部渗血3例,对症治疗后好转;(5)结果表明,糖尿病下肢血管病变患者行腔内治疗结合自体外周血干细胞移植加速患肢侧支循环的建立,从而减轻患肢缺血症状,因此能取得比单独采取腔内治疗更好的临床效果。BACKGROUND： Studies have found that peripheral blood stem cells can highly differentiate into vascular endothelial cells to promote blood vessel regeneration, and improve collateral circulation, thereby achieving satisfactory outcomes in the treatment of limb ischemia.OBJECTIVE： To observe the clinical effect in diabetic lower extremity vascular disease patients undergoing percutaneous transluminal angioplasty combined with autologous peripheral blood stem cell transplantation. METHODS： Fifty patients hospitalized for diabetic lower extremity vascular disease from March in 2011 to December in 2014 were collected： 25 cases underwent percutaneous transluminal angioplasty as control group; another 25 underwent percutaneous transluminal angioplasty combined with autologous peripheral blood stem cell transplantation as combination group. At 1, 6, 12 months after surgery, subjective scores of affected limb pain and cold sensation were recorded, additionally, objective indicators, including ankle-brachial index, transcutaneous oxygen partial pressure, and claudication distance were detected. RESULTS AND CONCLUSION： Ankle-brachial index scores of the two groups were significantly increased, especially at 1 month after surgery, but decreased at 6, 12 months, and there was a significant difference compared with that before treatment（P〈 0.05）; at 1, 6, and 12 months, there was no significant difference between the two groups（P 〉0.05）. At 1, 6, and 12 months after surgery, both of transcutaneous oxygen partial pressure and claudication distance in the two groups were significantly increased compared with those before treatment（P 〈0.05）. Furthermore, compared with the control group, these two indicators in the combination group were significantly increased（P 〈0.05）. Within 12-month follow-up, affected limb pain and cold sensation were improved in the two groups, especially in the combination group. Inevitably, three cases had hypocalcemia during the collection of peripheral blood stem cells,

关 键 词：外周血干细胞移植 血管成形术 糖尿病血管病变 组织工程 干细胞 移植 自体外周血干细胞 腔内治疗 糖尿病下肢血管病变 踝肱指数 经皮氧分压 跛行距离 

分 类 号：R394.2[医药卫生—医学遗传学]