骨髓动员与非动员自体骨髓源单个核细胞移植治疗血栓闭塞性脉管炎的疗效比较

目的观察骨髓动员与非动员自体骨髓干细胞移植治疗血栓闭塞性脉管炎（TAO）的疗效并进行对比分析。方法25例严重缺血的TAO患者分为A、B两组，A组12例为骨髓动员组，B组13例为非动员组。两组患者抽取骨髓血150～200ml，分离纯化后行下肢肌肉注射法移植术，观察丰观及客观指标进行疗效评价。结果移植2个月后两组多数患者疼痛和冷感有缓解，但缓解率两组无差异，两组溃疡愈合率无差异；经平均10个月随访，两组主观症状缓解率及溃疡愈合率差异无统计学意义（P〉0．05）。移植2个月后踝肱指数（ABI）和经皮氧分压（TcPO2）较术前有显著提高，A、B两组间差异有统计学意义；经平均10个月随访，两组间ABI和TcPO，差异有统计学意义（P〈0．05）。两组各有2例2条患肢溃疡无改善，无步匕亡及高位截肢者，全部患者无严重并发症发乍。结论骨髓动员和非动员两种方式自体骨髓干细胞移植均是安全、有效的治疗TAO手段．尤其对改善患肢症状及促讲溃疡的愈合效果明显，而骨髓动员组的疗效优于非动员组．

Autologous bone - marrow cell transplantation in treatment of thromboangiitis obliterans with versus without bone marrow stimulation

Objective To compare the clinical effectiveness of autologous bone marrow - mononuclear cell （BM- MNC） transplantation in the treatment of thromboangiitis obliterans （TAO） with or without bone marrow stimulation. Methods A total of 25 patients with severe TAO were divided into group A and group B. In group A, 12 patients were stimulated by an injection of recombinant human granulocyte - macrophage eolony - stimulating factor （GCSF） before transplantation. In group B, 13 patients were not stimulated by GCSF. Then 150 - 200 ml of bone marrow was aspirated from each patient, and BM - MNCs were obtained and transplanted into ischemic muscles. Subjective and objective indexes were used to evaluate the effectiveness. Results Two months after transplantation, the pain and the cold feeling were relieved in most patients in both groups,and there were no statistical differences in relief rates or skin ulcer healing rates between group A and group B （P 〉 0.05 ） ;During an average 10 -month follow-up, there were no statistical differences between two groups（ P 〉 0.05 ）. Two months after transplantation, ABI and TcPO 2 were significantly increased,and there were statistical differences in ABI and TcPO 2 between group A and group B （ P 〈 0.05 ） ; During an average 10 - month follow - up, there were statistical differences between two groups （ P 〈 0.05 ）. Skin ulcer were not healed in 2 patients respectively in group A and group B. No death,high level amputation or severe complications occurred. Conclusion In patients with TAO, BM - MNC transplantation with and without bone marrow stimulation are both safe and effective methods, which could significantly improve patients＇symptoms and accelerate the healing of skin ulcer. The treatment effectiveness of transplantation with bone marrow mobilized by GCSF could be better than that without mobilization.