自体外周血干细胞移植治疗下肢缺血性疾病

目的 观察自体干细胞移植治疗下肢缺血性疾病的临床疗效及部分影响因素.方法 下肢缺血性疾病病人15例,其中男性8例,女性7例;年龄44～77岁,平均年龄67.3岁.病人移植前均内科常规治疗半年以上,临床症状、体征未改善.应用自体干细胞移植治疗,按照操作规范和病人实际情况采集外周血干细胞(PBSC),全部病人均给予重组人粒细胞集落刺激因子300～600μg/d,皮下注射,行自体PBSC动员3～5d,然后用费森尤斯血细胞分离机采集PBSc,将干细胞悬液按3×3cm距离进行肢体移植术.术后第1天至3个月定期观察各项指标综合评估.结果 PBSC移植后3个月进行评价,全部病例下肢疼痛明显缓解,皮温升高,下肢冷感消失,14例感染得到控制,溃疡或足趾坏疽明显好转或愈合,足趾颜色由青紫色转为正常,肿胀消失,无1例病人行截肢术;有2例病人趾头已坏死在移植同时行截趾术;移植后所有病人均未出现并发症和明显不良反应.结论 自体PBSC移植治疗糖尿病下肢缺血性疾病是一种安全、有效的手段,可使一部分病人免除截肢,改善生活质量.

Clinical efficacy and impact factors of autologous peripheral blood stem cell transplantation for lower limb ischemic disease

Objective To observe the clinical efficacy and impact factors of autologous peripheral blood stem cells （PBSC） transplantation for ischemic lower extremity disorder. Methods A total of 15 patients with ischemic lower extremity disorder which diagnosed from May 2008 were enrolled, male 8, female 7, aged 44 - 77 years old, mean age 67.3 years old. The clinical symptoms and signs were not improved after routine medical treatment for more than 6-month before transplantation. The PBSC was collected according to the operating norms and actual situation of patient. The patients received recombinant human granulocyte colony stimulating factor（rhG-CSF） via subcutaneous injection to mobilize autologous PBSC for 3 to 5 days. The PBSC were collected with Fresenius blood cell separator, and prepared into stem cell suspension for limb transplantation by 3 ×3 cm distance. The comprehensive of indicators at 1-day to 3-month were assessed. Results The evaluation at 3-month followed transplantation were performed, severe pain lameness, skin temperature, coot-feeling were significantly improved of all patients. The ulcer and toe gangrene were relieved and even healed. Not only the toe color was from purple to normal, the swelling disappeared of all patients, but also the infection was controlled in 14 cases. There were no cases of amputation. There were 2 cases underwent transplantation while amputation. Compared with pre-transplantation, neither related complication nor adverse effect was observed. Conclusion It is demonstrated that autologous PBSC transplantation for ischemic lower extremity disorder is not only a safe and effective means to keep the patients from amputation, but also improve the quality of life.