摘要
目的回顾性分析自体干细胞移植治疗常规血运重建失败的重度肢体缺血患者的有效性。方法收集2009年5月至2015年12月复旦大学附属中山医院血管外科14例卢瑟福4~5级肢体缺血患者,术前均曾接受常规血运重建治疗,包括人工血管旁路术、动脉支架植入术等,中位年龄(48±15)岁,术后缺血无显著改善,或短期内复发。接受GCSF动员5 d后,进行外周血单个核细胞采集,获得移植物后,肌肉注射于缺血肢体。接受纯化CD34^+细胞移植治疗共计11例,外周血单个核细胞移植治疗共计3例。术后12个月保肢率使用Kaplan-Meier生存分析法分析,治疗前后疼痛评分、无痛步行时间差异比较采用配对t检验。结果 14例均获随访,平均(42±25)个月(12~74个月),1例死亡,2例截肢,死亡及截肢患者均为老年下肢动脉硬化闭塞症患者。术后2年总体生存率92.86﹪(13/14),无截肢生存率78.57﹪(11/14)。术前平均无痛步行时间(3±2)min,术后6个月(12±8)min,较术前显著改善(P<0.05,F=14.95)。术前平均Wong-Baker疼痛评分为7±1,平均静息痛缓解起始时间为术后(3±1)周,术后6个月疼痛评分为1±1,较术前显著改善(P<0.05,F=18.00)。结论自体干细胞移植治疗常规血运重建失败的重度肢体缺血患者安全有效。
Objective To evaluate the efficacy ofautologous stem cell transplantation in the treatment of critical limb isehemia after failure of conventional revascularization. Methods From May 2009 to November 2015, 14 patients with critical limb ischemia were enrolled and all of them had undergone conventional revascularization, including bypass surgery and stenting. The average age was 48±15 years （range, 21 - 75 ）. Conventional revascularization failed to improve ischemia in them. Apheresis was performed after 5-days＇ mobilization with GCSF to harvest stem cells. Stem cells were transplanted into the ischemic limb by intramuscular injection. Eleven patients were transplanted with purified CD34＋ cells and 3 patients with peripheral blood mononuclear cells. Results Followup was accomplished in all 14 patients with an average follow-up time of （42±25） months （range 12 - 74）. During the follow-up there were 1 death and 2 major amputations which all occurred in aged patients with atherosclerosis obliterans. The overall survival rate 2 years after transplantation is 92.86% （13/14） and the amputation free survival rate is 78.57% （11/14）. The peak pain-freewalking time at 6 months was significantly improved from （ 3 ± 2）minutes to （ 12 ± 8）minutes （P 〈 0.05, F = 14.95） and the Wong-Baker FACES pain rating score decreased from （74-1） to （14-1） （P 〈 0.05, F = 18.00）. Conclusions Autologous stem cell transplantation is safe and effective in treating critical limb ischemia after conventional revascularization failure.
作者
方圆
董智慧
魏征
符伟国
潘天岳
顾史洋
陈斌
郭大乔
徐欣
刘澎
蒋俊豪
杨珏
Fang Yuan Dong Zhihui Wei Zheng Fu Weiguo Pan Tianyue Gu Shiyang Chen Bin Guo Daqiao Xu Xin Liu Peng Jiang Junhao Yang Jue(Department of Vascular Surgery Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai 200032, China)
出处
《中华细胞与干细胞杂志（电子版）》
2017年第3期136-140,共5页
Chinese Journal of Cell and Stem Cell（Electronic Edition）
基金
复旦大学附属中山医院人才培养计划-优秀骨干计划(2015ZSYXGG02)
关键词
外周血管疾病
缺血
干细胞移植
移植
自体
Peripheral vascular diseases
Ischemia
Stem cell transplantation
Transplantation, autologous
