自体骨髓单个核细胞移植治疗下肢动脉闭塞症

背景：下肢缺血性疾病治疗中血管再生技术已成为研究的热点。目的：观察自体骨髓单个核细胞移植后下肢缺血性疾病患者肢体缺血症状的改善情况。方法：东南大学医学院附属江阴医院胸心血管外科及南京大学医学院附属南京市鼓楼医院血管外科于2007年10月至2011年10月采用自体骨髓单个核细胞治疗35例下肢缺血性疾病患者，抽取自体骨髓单个核细胞，沿下肢动脉走行路径进行多点注射，测定患肢疼痛程度、冷感缓解程度、踝肱指数、经皮氧分压及皮肤溃疡或坏疽面积的改变，动脉造影观察血管新生情况。结果与结论：①疼痛评分：骨髓单个核细胞移植后2个月和1年的疼痛评分均较移植前有下降趋势，差异有显著性意义(P < 0.05)。移植后2个月与移植后1年评分比较，差异无显著性意义(P > 0.05)。②冷感缓解程度：移植后2个月缓解率为51%，移植后1年缓解率为60%，与移植前比较差异有显著性意义(P < 0.05)。③踝肱指数的变化：移植2个月踝肱指数均较移植前有升高趋势，但差异无显著性意义 (P > 0.05)，移植后1年踝肱指数较移植前有明显增高，差异有显著性意义(P < 0.05)。④经皮氧分压的变化：对经皮氧分压增加值进行比较，移植后2个月及移植后1年均较移植前明显增加，差异有显著性意义(P < 0.05)，移植后1年与移植后2个月比较差异无显著性意义(P > 0.05)。⑤行走距离：移植后2个月和移植后1年的行走距离明显增加，与移植前比较差异有显著性意义(P < 0.05)，移植后1年与移植后2个月比较差异无显著性意义(P > 0.05)。⑥溃疡创面的变化：移植后2个月和1年的溃疡面积均较移植前有缩小趋势，差异有显著性意义(P < 0.05)。⑦新生血管评价：移植后股动脉造影显示缺血下肢注射骨髓单个核细胞的部位毛细血管增生明显，且与已有的毛细血管相互连接形成侧支循环，促进了缺血下肢的血液供应。

Autologous bone marrow mononuclear cell transplantation for treatment of lower limb ischemia

BACKGROUND:Vascular regeneration technology has attracted increasing attention in the treatment of lower limb ischemiaOBJECTIVE:To study and evaluate the effect of autologous bone marrow mononuclear cell transplantation on the improvement of symptoms of limb ischemia in patients with lower limb ischemia.METHODS:Thirty-five lower limb ischemia patients treated with autologous bone marrow mononuclear cell transplantation from October 2007 to October 2011 were selected from the Department of Cardiothoracic Surgery, the Affiliated Jiangyin Hospital of Southeast University Medical School and Nanjing Drum Tower Hospital of Nanjing University Medical School. Autologous bone marrow mononuclear cells were extracted from the patients and then multi-point injected into the patients along the lower limb arteries. Pain degree of the diseased limbs, alleviation of the sense of coldness, ankle-brachial index, transcutaneous oxygen pressure and the improvement of skin ulcer or gangrene area were observed and measured. Arteriography was conducted to observe the situation of vascular regeneration.RESULTS AND CONCLUSION:Pain scores: the pain score declined at 2 months and 1 year after transplantation when compared with that before transplantation, and the difference was significant (P < 0.05). There was no significant difference in pain score between 2 months after transplantation and 1 year after transplantation (P > 0.05). The alleviation of the sense of coldness: the remission rate was 51% at 2 months after transplantation and 60% at 1 year after transplantation; the difference was significant when compared with that before transplantation (P < 0.05). Ankle-brachial index: ankle brachial index was on a rising trend at 2 months after transplantation, and the difference was not significant (P > 0.05). Ankle-brachial index was significantly increased at 1 year after transplantation when compared with that before transplantation, and the difference was significant (P < 0.05). Transcutaneous oxygen pressure: the transcutaneous oxygen pressure at 2 months and 1 year after transplantation was significantly increased when compared with that before transplantation, and the difference was significant (P < 0.05). There was no significant difference of transcutaneous oxygen pressure between 2 months after transplantation and 1 year after transplantation (P > 0.05). Walking distance: the walking distances was significantly increased at 2 months and 1 year after transplantation, and there was significant difference of walking distance when compared with that before transplantation (P < 0.05). There was no significant difference of walking distance between 2 months and 1 year after transplantation (P > 0.05). Ulcer area: the ulcer area at 2 months and 1 year after transplantation was decreased, and the difference was significant (P < 0.05). Vascular regeneration evaluation: femoral arteriography conducted after autologous bone marrow mononuclear cell transplantation showed that capillary vessels in the site with bone marrow mononuclear cell injection were increased greatly, and limb circulation has already established between new capillaries and old capillaries, which improved the blood supply of lower limbs.