自体骨髓干细胞移植治疗下肢动脉缺血性疾病

目的了解自体骨髓干细胞移植治疗下肢动脉缺血性疾病的疗效.方法下肢动脉缺血性疾病病人45例共50条患肢,分为自体骨髓干细胞移植组和常规非手术治疗对照组,随访比较其疗效差异.结果随访满1年的自体骨髓干细胞移植组病人和对照组总体症状改善率分别为73.9%和33.3%,经比较有显著差异（P〈0.05）.结论自体骨髓干细胞移植是一种安全有效的治疗下肢动脉缺血性疾病的方法.     

自体骨髓干细胞移植治疗下肢慢性缺血性疾病疗效观察

目的 观察自体骨髓干细胞移植(ABMT)治疗下肢慢性缺血性疾病的疗效.方法 对下肢慢性缺血性疾病患者24例,采用抽取自体骨髓血,经沉淀、离心、分离等处理后提取骨髓干细胞,腓肠肌多点注射方法,行ABMT.结果 疼痛、冷感、间歇性跛行改善明显,有效率分别为75.0%、79.2%、83.3%.ABI指数均有显著改善,由术前0.25±0.08提高至0.58±0.12(P＜0.05),无不良反应.结论 ABMT是一种安全、有效的治疗下肢慢性缺血性疾病的方法.     

自体骨髓干细胞移植合中药治疗下肢动脉缺血

目的:研究自体骨髓单个核细胞移植与中药合用对重症下肢缺血的治疗作用.方法:采用自体骨髓,并分离单个核细胞,总量达到1×109以上,采用缺血肢体多点注射法移植,移植后口服益气活血中药.观察患者手术前后肢体疼痛评分、冷感评分、踝肱比(ABI)以及溃疡创面情况,评价治疗效果.结果:治疗后1周患者肢体疼痛评分及冷感评分明显下降,两周时又有回升,术后1个月再下降.ABI在术后逐渐升高,术后1个月平均升高0.23.3例有溃疡患者创面明显缩小,2例有严重坏死者术后1个月行截肢,创面一期愈合.结论:自体骨髓单个核细胞移植合用中药可以改善下肢缺血患者的临床症状及体征.     

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

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(9.63±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.     

自体骨髓干细胞移植联合中药治疗下肢动脉闭塞性疾病临床观察

目的:观察自体骨髓干细胞移植联合中药治疗下肢动脉闭塞性疾病的疗效.方法:本组20例病人用自体骨髓干细胞移植联合中药治疗下肢动脉闭塞性疾病.结果:静止痛20例,消失10例,显效6例,好转4例;间歇跛行20例,消失0例,显效15例,好转5例;溃疡、坏疽13例,消失6例,显效4例,好转2倒,无变化1例.结论:该疗法简单、安全、有效,创伤小,元排异反应.     

自体骨髓干细胞移植治疗糖尿病足1例

患者 ,男性 ,5 6岁 ,因糖尿病足反复溃疡 13年、伴视物不清、肢体麻木、行走不稳 3d于 2 0 0 4年 6月 2 1日入院。入院后查患者右足背表皮约 5cm× 5cm无痛感大泡 ,双足及小腿麻木、发凉 ,保护性感觉明显减退 ,踝部及小腿皮肤多处溃疡愈合后疤痕形成 ,色素沉着明显 ;血糖高 ,头颅CT示左侧侧脑室体旁、内囊前肢脑梗塞 ,踝肱压测定 (ABI)显示右侧为 0 99,左侧为 0 97,眼底荧光造影示双侧眼底微血管呈斑块状渗出 ,有微动脉瘤形成 ,核磁共振血管显影示双下肢大中动脉未见明确异常。诊断为 :① 2型糖尿病 ;②糖尿病性血管并发症 ;③糖尿病足 …     

自体骨髓干细胞移植治疗冠心病研究进展

冠心病已成为危害人类健康的主要疾病之一。近年来人们应用骨髓干细胞移植术治疗冠心病进行了大量的研究，取得了令人振奋的成果。本文就自体骨髓干细胞移植用于冠心病的治疗进展作一综述。     

自体骨髓干细胞移植治疗糖尿病足的护理

糖尿病足(diabetic foot,DF)是糖尿病的一种严重并发症,是下肢血管病变、神经病变和感染共同作用的结果.糖尿病足的传统治疗方法是控制血糖、抗炎、改善血液循环、局部换药等对症支持治疗,但治疗效果不理想.近来动物实验表明进行骨髓干细胞移植可促进缺血肢体的新生血管形成,提示有望用干细胞移植来治疗下肢缺血性疾病.国内外已成功地用于临床治疗糖尿病足[1～4].我科对25例糖尿病足患者采用自体骨髓干细胞移植治疗,取得了一定的治疗效果.现将其护理体会报告如下.     

经冠状动脉自体骨髓干细胞移植治疗缺血性心脏病1例

患者，男，退休工人，67岁，因冠状动脉（冠脉）内支架植入术后2年，活动后气促、胸闷2个月入院。患者2年前因持续胸痛10h，确诊为“急性广泛前壁心肌梗死”在外院行急诊经皮穿刺冠状动脉介入治疗（PCI）术，术后予以规范化抗血小板治疗，病情相对稳定。2个月前，患者活动后出现气促、胸闷，夜间需高枕卧位，夜间有阵发性呼吸困难，体力活动明显受限，病程中有心前区隐痛，含服硝酸酯类治疗有效。     

自体骨髓干细胞移植治疗肝硬化失代偿期患者的临床效果

目的:观察自体骨髓干细胞移植对肝硬化失代偿期患者的治疗效果.方法:选择肝硬化失代偿期患者19例,各抽取骨髓200 ml,在体外分离纯化骨髓干细胞并制成10 ml细胞悬液,经肝动脉将细胞悬液通过介入方法移植入肝脏,移植后第4周复查肝功能、凝血酶原时间(PT)、胆碱酯酶(CHE)和甲胎蛋白(AFP)等指标及临床症状和体征.结果:移植后第4周,血浆白蛋白由(32.9±4.3) g·L-1升至(35.6±3.2) g·L-1(P<0.05),天门冬氨酸氨基转移酶(AST)由(74.3±20.3) U·L-1降至(48.3±13.8) U·L-1(P<0.05),丙氨酸氨基转移酶(ALT)、总胆红素水平在移植前后无显著性变化,PT由术前(23.7±4.8) s降至(19.3±3.1) s(P<0.05),AFP由术前(12.5±5.6) ng·ml-1升至(24.7±9.7) ng·ml-1(P<0.05),CHE虽有所上升,但差异无统计学意义.干细胞移植后食欲改善、体力好转6例,腹胀减轻7例,腹水减少7例,胸水减少3例,下肢浮肿减轻5例.全部患者在移植中未发生严重并发症,移植近期无不良反应出现.结论:自体骨髓干细胞移植术可使失代偿期肝硬化患者肝功能明显改善,治疗安全有效且副作用小,可作为中晚期肝硬化患者的临床治疗方案.     

Autologous transplantation of bone marrow mesenchymal stem cells on diabetic patients with lower limb ischemia

Objective： To study the efficacy and safety of autologous transplantation of bone marrow mesenchymal stem cells on diabetic patients with lower limb ischemia. Methods： Fifty Type 2 diabetic patients with lower limb ischemia were enrolled and randomized to either transplanted group or control group. Patients in both group received the same conventional treatment. Meanwhile, 20 ml bone marrow from each transplanted patient were collected, and the mesenchymal stem cells were separated by density gradient centrifugation and cultured in the medium with autologous serum. After three-weeks adherent culture in vitro, 7.32×10^8-5.61×10^9 mesenchymal stem cells were harvested and transplanted by multiple intramuscular and hypodermic injections into the impaired lower limbs. Results： At the end of 12-week follow-up, 5 patients were excluded from this study because of clinical worsening or failure of cell culture. Main ischemic symptoms, including rest pain and intermittent claudication, were improved significantly in transplanted patients. The ulcer healing rate of the transplanted group （1 5 of 18, 83.33%） was significantly higher than that of the control group （9 of 20, 45.00%, P=0.012）.The mean of resting ankle-brachial index （ABI） in transplanted group significantly was increased from 0.61±0.09 to 0.74±0.11 （P〈0.001）. Magnetic resonance angiography （MRA） demonstrated that there were more patients whose score of new vessels exceeded or equaled to 2 in the transplant patients （11 of 15） than in control patients （2 of 14, P=0.001）. Lower limb amputation rate was significantly lower in transplanted group than in the control group （P=0.040）. No adverse effects was observed in transplanted group. Conclusion： These results indicate that the autologous transplantation of bone marrow mesenchymal stem cells relieves critical lower limb ischemia and promotes ulcers healing in Type 2 diabetic patients.     

自体骨髓干细胞移植治疗心肌梗死的临床研究

目的研究自体骨髓干细胞经冠脉移植对心肌梗死患者心功能的影响及其安全性。方法6例冠心病伴心肌梗死患者,男5例、女1例,平均年龄62岁(51~75岁),体外分离培养自体骨髓干细胞2~3周,开通梗死相关“罪犯”血管,通过冠脉转运将骨髓干细胞植入患者的心肌梗死区,移植的骨髓间充质干细胞数为(0.9~3.2)×106个,骨髓单个核细胞数为(1.6~5.3)×106个。术前和术后6个月分别行99mTc-MIBI心肌灌注显像、二维超声心动图、心电图和动态心电图检查。结果6例患者二维超声心动图检查示左室射血分数(LVEF)较术前明显增加[(52.33±8.70)%vs(42.92±12.60)%,P<0.05],左室舒张期内径(LVDd)较术前明显减少[(54.33±4.84)vs(61.67±6.83),P<0.05];6例99mTc-MIBI检查显示梗死部位心肌灌注明显改善。术中及术后随访6~18个月无心律失常和其他合并症发生。结论进行自体骨髓干细胞经冠脉移植治疗冠心病、心肌梗死具有抑制左室重构、改善心脏功能的作用。     

兔自体骨髓干细胞移植联合骨髓动员治疗下肢缺血的实验研究

目的：探索自体骨髓干细胞移植联合骨髓动员治疗下肢缺血性疾病的可行性。方法：于2008年3月-2008年6月进行兔骨髓干细胞移植联合骨髓动员治疗下肢缺血实验研究。建立新西兰雄兔右后肢缺血动物模型,将其分为4组：实验1组（7只）单纯应用重组粒细胞集落刺激因子进行骨髓动员,实验2组（7只）取自体骨髓干细胞制备成干细胞悬液,注射于右后肢缺血部位,实验3组（7只）为自体骨髓干细胞移植后进行骨髓动员组,4组（7只）为生理盐水注射组,于动物模型制备后第5周行血管造影观察血管新生程度,CD34免疫组化检测毛细血管密度。结果：动脉造影显示进行骨髓干细胞移植联合骨髓动员的新西兰雄兔缺血右后肢缺血部位动脉较其他组明显增多,CD34免疫组化标记毛细血管密度增加。结论：自体骨髓干细胞移植联合骨髓动员是一种方法简便、安全有效的治疗下肢缺血性疾病的方法。     

Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia

Background Many treatment options for lower limb ischemia are difficult to apply for the patients with poor arterial outflow or with poor general conditions. The effect of medical treatment alone is far from ideal, especially in patients with diabetic foot. A high level amputation is inevitable in these patients. This study aimed to explore the effect of transplantation of autologous bone marrow mononuclear cells on the treatment of lower limb ischemia and to compare the effect of intra-arterial transplantation with that of intra-muscular transplantation.
Methods In this clinical trial, 32 patients with lower limb ischemia were divided into two groups. Group 1 （16 patients with 18 affected limbs） received transplantation of autologous bone marrow mononuclear cells by intra-muscular injection into the affected limbs; and group 2 （16 patients with 17 affected limbs） received transplantation of autologous bone marrow mononuclear cells by intra-arterial injection into the affected limbs. Rest pain, coldness, ankle/brachial index （ABI）, claudication, transcutaneous oxygen pressure （tcPO2） and angiography （15 limbs of 14 patients） were evaluated before and after the mononuclear cell transplantation to determine the effect of the treatment.
Results Two patients died from heart failure. The improvement of rest pain was seen in 76.5% （13/17） of group 1 and 93.3% （14/15） of group 2. The improvement of coldness was 100% in both groups. The increase of ABI was 44.4% （8/18） in group 1 and 41.2% （7/17） in group 2. The value of tcPO2 increased to 20 mmHg or more in 20 limbs. Nine of 15 limbs which underwent angiography showed rich collaterals. Limb salvage rate was 83.3% （15/18） in group 1 and 94.1% （16/17） in group 2. There was no statistically significant difference in the effectiveness of the treatment between the two groups.
Conclusions Transplantation of autologous bone marrow mononuclear cells is a simple, safe and effective method for the treatment of lower limb ischemia,     

自体骨髓干细胞移植治疗失代偿期肝硬化的初步观察

【目的】评价自体骨髓干细胞移植治疗失代偿期肝硬化的近期临床疗效。【方法】肝硬化失代偿期患者21例,抽取自体骨髓140~200 ml,在体外分离纯化骨髓干细胞制成10~20 ml细胞悬液,经肝动脉介入移植入肝脏,分别在移植后第4、8、12周复查肝脏功能,观察实验室指标、临床症状及不良反应情况。【结果】移植后第12周,血清学指标如谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、凝血酶原时间(PT)较术前均有明显降低(P<0.05),胆碱酯酶(CHE)、白蛋白(ALB)较术前增高(P<0.05)。自体骨髓干细胞移植对肝硬化失代偿期患者症状、体征的影响:腹水减少、下肢浮肿减轻、尿黄减轻皆为8/10例;食欲改善、乏力好转皆为13/21例;腹胀减轻15/21例。21例患者术中未发生严重并发症,有1例半年后出现胰腺癌,1年后死亡。【结论】自体骨髓干细胞移植治疗可使肝硬化失代偿期患者肝脏功能明显改善,治疗安全有效且副作用小,为中晚期肝硬化患者提供又一种临床治疗方法。     

自体骨髓间质干细胞移植治疗急性脑卒中 49 例临床分析

目的 观察自体骨髓间质干细胞移植治疗急性脑卒中患者的临床效果及安全性.方法 选择2010年1月～2012年12月江西省人民医院神经内科收治的急性脑卒中患者49例,其中脑出血16例,脑梗死33例.患者在病情稳定后予以粒细胞集落刺激因子进行骨髓干细胞动员,采自体骨髓间质干细胞进行鞘内注射移植治疗,骨髓间质干细胞数量为（1.0～10.0）×107,1次/周,共治疗2次.参照美国国立卫生研究院脑卒中量表（NIHSS）、简化Fugl-Meyer运动评分法（FMA）.改良Barthel指数（MBI）,对患者术前、术后神经功能缺损程度、运动功能和日常生活能力进行评定,观察患者的不良反应和副作用.结果 49例患者均进入结果分析,中途无脱落.与治疗前比较,患者移植后1、6、12个月后NIHSS评分显著降低,差异有统计学意义（P＜0.05）、FMA和MBI显著升高,差异均有高度统计学意义（P＜0.01）.术后出现10例低热和6例低颅压性头痛,临床处理后症状完全消失.随访12个月,头颅MRI和肿瘤标志物均未见异常.结论 自体骨髓间质干细胞移植可以一定程度地改善急性脑卒中患者的临床症状,提高生活质量,不良反应轻微.     

Autologous bone marrow stem cell transplantation in critical limb ischemia: a meta-analysis of randomized controlled trials

Background  Amputation-free survival (AFS) has been recommended as the gold standard for evaluating No-Option Critical Limb Ischemia (NO-CLI) therapy. Early-phase clinical trials suggest that autologous bone-marrow derived cells (BMCs) transplantation may have a positive effect on patients with NO-CLI, especially decreasing the incidence of amputation. However, the BMCs therapeutic efficacy remains controversial and whether BMCs therapy is suitable for all CLI patients is unclear.

Methods  We conducted a meta-analysis using data from randomized controlled trials (RCTs) by comparing autologous BMCs therapy with controls in patients with critical limb ischemia, and the primary endpoint is the incidence of amputation. Pubmed, EBSCO and the Cochrane Central Register of Controlled Trials (to approximately July 25, 2012) were searched.

Results  Seven RCTs with 373 patients were enrolled in the meta-analysis. Because serious disease was the main reason leading to amputation in one trial, six studies with 333 patients were finally included in the meta-analysis. Pooling the data of the final six studies, we found that BMCs therapy significantly decreased the incidence of amputation in patients with CLI (odds ratio (OR), 0.37; 95% confidence interval (CI), 0.22 to 0.62; P=0.0002), and the efficacy had not significantly declined within 6 months after BMCs were transplanted; OR, 0.33; 95% CI, 0.16 to 0.70; P=0.004 within 6 months and OR, 0.30; 95% CI, 0.11 to 0.79; P=0.01 within 3 months. The rate of AFS after BMCs therapy was significantly increased in patients with Rutherford class 5 CLI (OR 3.28; 95% CI, 1.12 to 9.65; P=0.03), while there was no significant improvement in patients with Rutherford class 4 (OR 0.35; 95% CI, 0.05 to 2.33; P=0.28) compared with controls. The BMCs therapy also improved ulcer healing (OR, 5.83; 95% CI, 2.37 to 14.29; P=0.0001).

Conclusions  Our analysis suggests that autologous BMCs therapy has a beneficial effect in decreasing the incidence of amputation and the efficacy does not decrease significantly within 6 months after BMCs transplantation. Patients with Rutherford class 5 are suitable for BMCs therapy, while the efficiency in patients with Rutherford 4 needs further evaluation.

     

自体骨髓干细胞移植治疗帕金森病32例

目的观察自体骨髓干细胞移植治疗帕金森病患者的临床疗效及安全性。方法选择2010年1月～2012年7月江西省人民医院神经内科收治的帕金森病患者32例．患者骨髓干细胞动员后,采自体骨髓干细胞进行鞘内注射移植治疗,骨髓干细胞数量为（1．0—10．0）×10^7个／L,1次／周,共治疗2次。以治疗前后统一帕金森病评定量表（UPDRS）各项评分的变化为指标评估疗效,并观察患者的不良反应。结果32例患者均进入结果分析,中途无脱落。患者移植后1、3个月的UPDRS评分较移植前均明显降低（均P〈0．05）,其中运动功能和日常生活能力明显改善（均P〈0．01）,治疗6个月后UPDRS评分与移植前比较,差异无统计学意义（P〉0．05）。患者移植术后1、3、6个月临床症状的改善率分别为71．9％、78．1％和31．3％。有6例低热和2例低颅压性头痛．处理后症状完全消失。结论自体骨髓干细胞移植不良反应轻,在短期内可以一定程度地改善帕金森病患者的临床症状,提高患者的生活质量,但疗效不持久。     

PDCA循环护理干预对自体骨髓干细胞移植治疗肝硬化患者的影响

目的探讨PDCA循环护理干预对自体骨髓干细胞移植治疗肝硬化患者的影响,旨在提高患者对治疗的依从性,提高患者生活质量,提高移植的疗效和成功率。方法应用PDCA循环法对16例自体骨髓干细胞移植治疗肝硬化患者进行护理干预。结果通过PDCA循环护理干预,减少了自体骨髓干细胞移植治疗并发症的发生,使患者接受新技术的依从性提高,使手术能够顺利进行,成功率100%。结论 PDCA循环护理干预对自体骨髓干细胞移植患者不断进行评估、分析并制定相应的护理干预对策,能有效提高患者移植疗效和成功率。