【摘要】 目的观察自体骨髓单个核细胞(BMMNCs)移植、粒细胞集落刺激因子(G-CSF)动员的自体外周血单个核细胞(PBMNCs)移植治疗外周动脉病的临床疗效。方法将69例外周动脉病患者随机分成3组:G-CSF动员的自体PBMNC移植组(PBMNC组)30例,给予G-CSF 600mg/d,皮下注射,连用4d,第5d采集PBMNCs移植至患肢;自体BMMNC移植组(BMMNC组)15例,采集骨髓液500~800ml,分离BMMNCs移植至患肢;常规内科治疗组(对照组)24例,仅给予常规药物治疗。术后3月随访所有患者,观察评价各项指标。结果PBMNC组CD34+细胞数[(3.31±1.39)×106/kg]显著多于BMMNC组[(1.42±0.42)×106/kg,P<0.01)]。移植后3月时复查,PBMNC组和BMMNC组的静息痛改善率分别为76.67%和73.33%均显著高于对照组16.67%(P<0.01);PBMNC组的溃疡改善率为40.0%,BMMNC组为42.86%,与对照组比较差异均无统计学意义(P>0.05);两个移植组之间静息痛改善率和溃疡改善率差异均无统计学意义(P>0.05)。两个移植组术后3月时,最大无痛步行距离(MWD)、踝臂压指数(ABI),经皮氧分压(TcO2)均明显高于治疗前(P<0.01),对照组治疗前后无差异(P>0.05)。△MWD、△ABI、△TcO2分别指治疗前和治疗后3月时MWD、ABI、TcO2的差值,比较两个移植组[(108.75±66.70)m vs(113.75±63.86)m,(0.082±0.05)vs(0.077±0.051),(10.54±5.90)mm Hg vs(9.63±5.26)mm Hg)]差异均无统计学意义(P>0.05)。PBMNC组和BMMNC组的DSA显效率分别为66.67%和62.50%均显著高于对照组0%(P<0.01,P<0.05)。两个移植组之间无差异(P>0.05)。结论自体PBMNC移植和自体BMMNC移植均为治疗外周动脉病安全有效的新方法,两者疗效相当。更多还原

【Abstract】 Objective To observe the clinical efficacy of autologous implantation of bone marrow mononuclear cells(BMMNCs)and granulocyte colony-stimulating factor(G-CSF)mobilized peripheral blood mononuclear cells((PBMNCs)in treatment of peripheral arterial disease(PAD).Methods Sixty-nine patients with PAD were randomly assigned to 3 groups:the PBMNC group(n=30),BMMNC group(n=15),and the control group(n=24).In the PBMNC group,after administration of G-CSF(600mg/d)by subcutaneous injection for 4 days,PBMNCs were harvested and implanted into the ischemic limb on the fifth day;In the BMMNC group,between 500 and 800ml of bone marrow was collected from each patient,BMMNCs were separated and implanted;the control group was treated with conventional drug therapy only.All of the patients were followed up after at least 3 months.Results The number of implanted CD34+cells in the PBMNC group[(3.31±1.39)×106/Kg] were significantly more than the BMMNC group[(1.42±0.42)×106/Kg,P<0.01].At the end of the 3-months follow-up,the improvement rate of rest pain was 76.67% and 73.33% in PBMNC group and BMMNC group respectively,both were significantly higher than that of the control group(16.67%,P<0.01),and there were no significant difference between implantation groups(P>0.05).The improvement rate of ischemic ulcer was 40.0% and 42.86% and 8.33%in PBMNC group and BMMNC group and control group respectively,and there were no differences among three groups(P>0.05).Three months after treatment,the maximum pain-free walking distance(MWD),and ankle-brachial pressure index(ABI)and transcutaneous oxygen pressure(TcO2)increased significantly in implantation groups(P<0.01),but no such impovements were seen in the control group(P>0.05).The MWD,ABI,TcO2 were defined as the change in MWD,ABI,TcO2 between the pre-treatment measurement and that obtained three months after treatment,and were(108.75±66.70)m vs(113.75±63.86)m,(0.082±0.05)vs(0.077±0.051),(10.54±5.90)mm Hg vs(9.63±5.26)mm Hg in the PBMNC group and the BMMNC group respectively,and there were no significant difference between both groups(P<0.05).The effective rate of digital subtraction angiography(DSA)was 66.67% and 62.50% in the PBMNC group and BMMNC group respectively,and both were remarkedly higher than that in the control group(P<0.01,P<0.05)and there were no difference between implantation groups(P>0.05).Conclusion Both the autologous implantation of BMMNCs and the autologous implantation of G-CSF-Mobilized PBMNCs were safe,effective,and novel therapeutic approach for PAD.更多还原