自体骨髓干细胞移植治疗严重慢性下肢缺血性疾病15例

严重慢性下肢缺血患者其下肢远端没有良好的流出道，故无法接受手术搭桥。植入自体骨髓干细胞移植后缺血下肢可形成新生血管，建立侧支循环，改善肢体血供，以达到细胞性血管搭桥目的。选择2006—06／2007—02沈阳市第七人民医院内分泌科住院确诊的严重慢性下肢缺血性疾病患者15例，患肢均有不同程度的静息痛、缺血性溃疡或趾端坏疽，踝臂指数0～0．5，CTA及彩超证明为周围动脉闭塞性病变，病变远端流出道差，患者对本实验知情同意且自愿接受自体骨髓干细胞移植术，排除并发严重的心、肺、脑等脏器功能不全不能耐受手术者，实验经医院医学伦理委员会批准。于双髂后上棘穿刺采集自体骨髓血，每例采集骨髓血100—300mL，羟乙基淀粉及Ficoll液分离，配置成干细胞混悬液50mL，单个核细胞计数为（2．05～9．36）×108。椎管内麻醉，沿下肢动脉走行给予缺血下肢肌肉及足部局部注射移植自体骨髓干细胞混悬液，术后给予常规药物治疗。移植后12周患者肢体疼痛、患肢冷感明显减轻，皮肤温度升高，间歇跛行距离延长（r=-5．328-6．373，P〈0．01）；踝臂指数略微升高（P〉0．05）；肾功能不全者血肌酐略微降低（P〉0．05）。9例缺血性足溃疡患者的足部创面于术后3-12周基本愈合；2例趾端坏疽患者在干细胞移植术中进行坏疽部位截趾，术后4周完全愈合。术后均未出现异常症状或体征，随访6个月无不良反应发生。提示自体骨髓干细胞移植术能够增加严重慢性缺血患肢的血流灌注，明显改善肢体疼痛、冷感、间歇跛行等指标，且不会加重并发肾功能不全患者的肾功能损伤，安全有效。

Autologous bone marrow stem cell transplantation for severe chronic lower limb ischemia in 15 cases

Patients with severe chronic lower limb ischemia cannot receive bypass grafting, due to lack of good outflow tract. After autologous bone marrow stem cell transplantation, neovascularization and compensatory circulation were found in ischemic low limbs, which can improve blood supply. Totally 15 patients with severe chronic lower limb ischemia were selected at the Department of Endocrinology of Seventh People Hospital from June 2006 to February 2007. There were rest pain, ischemic ulcer and feet necrosis. The ankle-brachial index was from 0-0.5. Ambient artery obturated and incommodious disease were proved by CTA or Color Doppler Flow Imaging （CDFI）. Patients singed the informed consents. The experimental procedures were approved by hospital ethical committee. Exclusive criteria： Having severe function failure in heart, lung or brain and failed to bear operation. Autologous bone marrow was collected from double ilium, about 100- 300 mL bone marrow blood from each case, and separated by Hydroxyethyl and Ficoll. 50 mL mixture of stem cell with count of （2.05-9.36） × 10^8 was confected. Stem cells were injected into leg muscles and feet running along the lower extremity arteries for transplantation when patients were in spinal anesthesia. Conventional drugs were used after surgery. Twelve weeks after transplantation, limb aching, cold-feeling and intermittent limp, temperature of skin were significantly relieved （t=-5.328-6.373, P 〈 0.01）. Ankle-brachial index was elevated （P 〉 0.05）. The blood creatinine in patients with chronic renal failure was lower （P 〉 0.05）. Wound surface defection in 9 patients with ischemic foot ulcer was healed mostly. Two patients accepted autologous transplantation of bone marrow stem cells. Meanwhile, the necrosis tissue was cleaned thoroughly from foot and the necrosis toe was cut. The wound was healed completely 4 weeks after surgery. There were no abnormal symptom or physical sign after autologous transplantation of bone-marrow stem cells. After 6-month f