摘要
目的探讨自体外周血干细胞（PBSC）移植改善股骨头坏死缺血状态的机理和临床效果。方法2006年1月～10月46例缺血性股骨头坏死患者接受自体PBSC移植治疗，按国际分期标准（ARCO）分期，设自身前后对照方法进行疗效观察。46例患者经GM-CSF和G-CSF联合外周血千细胞动员4d，第5天用COBE6．1SpectraVersion采集单个核细胞50～68ml，总数（2～8）×10^9，CD34^＋细胞（2188±1.30）％，CD133^＋细胞（1．89±0．76）％。在DSA下行旋股内、旋股外及闭孔动脉千细胞移植术，移植后第1、3、6个月观察患者髋关节疼痛程度、疼痛性质及持续时间变化、行走间距及步态变化、髓关节外展与内旋功能变化。6个月后复查股骨头供血动脉造影，观祭血管新生及股骨头供血动脉充盈情况，6个月复查影像学变化。结果46例患者随访1～9个月（平均4.7个月），髋关节疼痛缓解38例（82．6％），关节功能改善23例（50．0％），30例（65．2％）行走间距延长。干细胞移植术后3～6个月3例患者行DSA股骨头供血动脉造影检查，显示股骨头供血动脉较移植前明显增多、增粗，血流速度增快。6个月复查影像学股骨头无变化。结论自体PBSC移植3～6个月左右在股骨头区有新生血管形成，髋关节疼痛减轻，功能改善，行走间距延长。经动脉自体PBSC移植方法简便，安全有效，对缺血病变的股骨头无再次损伤，患者依从性好，在治疗中未发生任何不良反应，是治疗缺血性股骨头坏死的一种新手段。
Objective To observe the curative effects of peripheral blood stem cell （PBSC） transplantations on the avascular necrosis of femoral head （ANFH）. Methods Totally 46 ANFH patients treated by PBSC transplantations were enrolled from January 2006 to October 2006.All of them were classed to different stages according to the ARCO. Control group were desired as themselves before and alter treatment. 46 patients were mobilized by GM-CSF combined with G-CSF for 4 days. On the fifth day 50～68ml of PBSC with total （2～8）×10^9 cells were collected by COBE 6.1Spectra Version. The concentration of CD34^＋ cells and of CD133^＋ cells was （2.88± 1.30）% and （1.89 ± 0.76）% respectively. The puncture of femoral artery was conducted with digital subtraction angiography （DSA）,and the tubes were inserted into medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery with the cell suspensions were gradually poured into the arteries. The level ,character, time change of coxa paining, and walking distance, gait change, change of abduction and medial rotation in patients were observed in the follow-ups after transplantations; the 3 patients were re-examined with femoral head blood-sttpply artery angiography to observe the neonatal vessels, the filling of blood-supply artery after 6 months of transplantation. Every other 6 months the change of angiography was re-examined. Results The joint paining, joint functions and walking distance of 46 patients were detected for the follow-up. There were 38 （82.6%） patients showing the remission of coxa joint paining on different degrees; 23 patients （50,0%） showing the improvement of joint functions： 30 showing the longer walking distance （65,2%）, Compared with before treatment, the calibers thickened; vessels increased and blood velocity quickened of femoral head blood-supply artery were observed in 3 patients after 6 months checked by DSA. Conclusion Autologus PBSC transplantation results in the new bone formation and improvement of ischemia in areas of femoral head necrosis at 6 months. The change of angiography was observed about 12 to 24 months after cell transplantation. The stem cell transplantation is convenient, safe and effective in the treatment of the ANFH with no adverse reaction, and can be considered as a new therapy of ANFH..
出处
《中华临床医学杂志》
2006年第11期9-11,共3页
Chinese Journal of Clinical Practical Medicine
关键词
外周血干细胞移植
股骨头坏死
血管
新生
Peripheral blood stem cell transplantation Necrosis olin：moral head Ischemia Angiogenesis
