应用干细胞移植治疗糖尿病足的临床研究.docVIP

应用干细胞移植治疗糖尿病足226001 　【摘　要】　目的　观察自体骨髓干细胞移植治疗糖尿病足的临床疗效。方法　应用自体骨髓干细胞移植治疗64例糖尿病足患者,采集自体骨髓200～250ml,用淋巴细胞分离液以梯度离心法分离,配成单个核细胞悬浊液约50ml 供移植用,计数单个核细胞总数为(4～8)×108/ml ,行下肢缺血肌肉局部注射。结果　大部分患者肢体疼痛缓解,冷感、间歇性跛行均有不同程度的改善，12周46例溃疡明显好转,踝肱压指数(ABI)35例患者改善,能提高患者生活质量。 【关键词】　骨髓干细胞；移植; 糖尿病足 Application of stem cell transplantation for treatment of diabetic foot in clinical research Abstract: Objective　To observe the clinical efficacy and safety of autologous bone marrow stem cells transp lantation in the treatment of diabetic disorder. Methods　Totally patients with diabetic feet were treated by autologous bone marrow transplantation. 200～250 ml autologous bone marrow blood was extracted , mononuclear cell suspension was isolated to 50ml in vitro by the mathod of gradient centrifugation and injected into lower extremity. The total number of mononuclear cells is (4 ~ 8) × 108/ml. The clinical and laboratory findings were monitored during three months after operation. Results Feet pain and cold sensation of lower limbs began to improved after operation. The waking distance extended. Conclusions　Autologous bone marrow stem cells transplantation may be a simple, safe and effective method for lower extremity ischemic disorder. It can improve the quality of life of many patients key words: bone marrow stem cells; transplantation; diabetic foot 糖尿病足是指因糖尿病血管病变和(或)神经病变及感染等因素，导致糖尿病患者足或下肢组织破坏的一种病变，是糖尿病的严重并发症之一，保守治疗难以取得令人满意的效果。干细胞具有高度增殖和分化体内各种细胞的潜能,经自体外周血干细胞经皮动脉腔内移植联合缺血部位肌肉注射治疗糖尿病性下肢缺血性病变—糖尿病足,可促进局部血管生成,疗效显著。现将2007年8月至2009 年8 月收治我院确诊为糖尿病足患者收集64例予干细胞移植情况进行总结、报告如下。 1 　资料与方法 1．1 　临床资料　64例糖尿病足患者,年龄57～72 岁,平均65 岁;其中男42例,平均年龄67.5 岁,女22例,平均年龄63.7 岁。入选病例符合ADA 制订的糖尿病诊断标准及按wagner 糖尿病足的诊断标准。共有患肢86条,其中单纯神经病变14例,合并下肢动脉闭塞症、脑梗塞、神经病变9例,合并神经病变、下肢动脉闭塞症6 例,合并陈旧心梗、下肢动脉闭塞症41例。并严格掌握其适应证及禁忌证。 1.2 　治疗方法 1. 2. 1 　自体干细胞提取: 64例患者在严格无菌条件下,2 %利多卡因局部麻醉,由双侧髂后上棘采集骨髓200～250 ml(肝素抗凝)。在超净工作台上应用淋巴细胞分离液以梯度离心法进一步分离,配成单个核细胞悬浊液约50ml供移植用,计数单个核细胞总数为(4～8)×108Pml 。 1. 2. 2 　自体干细胞移植: 64例患者术前30 min 给予吗啡10 mg 肌肉注射,2 例在手术室硬膜外麻醉下进行。将干细胞混悬液沿血管体表投影多点肌肉