能增强骨髓源单个核细胞治疗下肢缺血的作用.pptVIP

Objective Can pre-treatment with G-CSF enhance the harvest of BM-MNC，then decrease the BM harvest, but enhance the angiogenic efficacy to treat lower limb ischemia? Retrospective Study * historical control Group 1 Group 2 * G-CSF + MNC MNC Inclusion criteria Severe claudication Rest pain Non-healing ulcer Gangrene Patients were not candidates for endovascular or vascular surgery duo to lack of either suitable conduit lack of suitable anastomotic targets Poor medical condition Exclusion criteria Poorly-controlled diabetes (HbA1C6.5g/dl) Confirmed malignancy during the past 5 years, or elevated serum tumor markers preoperatively (CEA,PSA,CA-153) Angina End stage organ failure (heart, liver kidney) Sepsis Limb necrosis requiring amputation independent of blood flow Group 1: +G-CSF Group 2 Control No. of patients (limbs) 35 (43) 103 (111) Mean Age 71.3 69.5 Gender Male Female 23 12 59 35 Ischemic Status of Limbs Claudication Rest Pain Ischemic Ulcer Gangrene 5 (5) 15(19) 9 (12) 6 (7) 12(13) 40(43) 26(28) 25(27) Co-morbidity Diabetes Non-Diabetic Thromboangiitis Obliterans 30 (38) 2 (2) 3(3) 88 (94) 8 (9) 7 (8) G-CSF pre-treatment 300μg/d IH, Qd, for 2 days WBC increased to 23 (15 ~ 38) ×109 /L Precaution against MI, stroke LMWH 40-60 mg ,IH, Bid Aspirin 100 mg ,Qd Harvest of BM- MNCs local anesthesia (1% lidocaine ) Aspiration of bone-marrow from the posterior superior iliac crest remove bone spicules and erythrocytes density gradient centrifugation（Percol 1.077, 400g, 20min） BM-MNC Implantation Gp1 Gp2 IM 13(19) 67(71) IA 16(16) 28(30) IM+IA 6 (8) 8 (10) I M I A Delivery routes No significant difference in therapeutic effect has been reported between the delivery routes. Gu,et al. Chin J Clin Rehab,2004, 8 (35)：7970-2.; Guo,et al. Chin J Clin Rehab, 2005, 9(10):57-9 ResultsBM-MNC Harvested 10.8 fold increase in MNC when corrected for each ml of BM harvested Vol of BM No. of