CAJ | 학술논문

背景:糖尿病下肢动脉闭塞的传统治疗方法如药物、介入等效果不佳,干细胞移植是近几年治疗该病变的新方法,临床取得了较好的效果.评价干细胞移植的治疗效果造影检查损伤大,费用高,所以采用彩色多普勒超声进行下肢动脉无创性检查具有重要的临床价值.目的:应用彩色多普勒超声评价自体外周血干细胞移植后下肢动脉病变的改善情况,并与血管造影结果相比较.方法:纳入确诊糖尿病下肢动脉闭塞症患者41例,经重组人粒细胞集落刺激因子150 μg皮下注射,1次/d进行外周血干细胞动员,第5天用血细胞分离机采集分离干细胞,配成干细胞悬液,将干细胞悬液肌肉注射进行双下肢移植(3×109细胞/肢).干细胞移植后观察3个月至1年,同时进行各项指标的综合评估.结果与结论:干细胞移植后,患肢疼痛、冷感、间歇性跛行、溃疡明显好转,踝臂指数明显升高(P＜0.01),彩色多普勒超声测量足背动脉血流速度明显增加(P＜0.01).移植后下肢动脉管腔血流有不同程度改善,闭塞动脉周围、肌肉内的侧支血管增多;螺旋CT血管造影显示新生侧支血管明显增多.41例患者均未发生并发症和不良反应.提示彩色多普勒超声可准确、快速地检测和评价干细胞移植后下肢血运改善情况,和血管造影结果相吻合,在评价干细胞移植治疗糖尿病下肢动脉闭塞症的疗效方面能为临床提供可靠的诊断依据.
배경:당뇨병하지동맥폐새적전통치료방법여약물、개입등효과불가,간세포이식시근궤년치료해병변적신방법,림상취득료교호적효과.평개간세포이식적치료효과조영검사손상대,비용고,소이채용채색다보륵초성진행하지동맥무창성검사구유중요적림상개치.목적:응용채색다보륵초성평개자체외주혈간세포이식후하지동맥병변적개선정황,병여혈관조영결과상비교.방법:납입학진당뇨병하지동맥폐새증환자41례,경중조인립세포집락자격인자150 μg피하주사,1차/d진행외주혈간세포동원,제5천용혈세포분리궤채집분리간세포,배성간세포현액,장간세포현액기육주사진행쌍하지이식(3×109세포/지).간세포이식후관찰3개월지1년,동시진행각항지표적종합평고.결과여결론:간세포이식후,환지동통、랭감、간헐성파행、궤양명현호전,과비지수명현승고(P＜0.01),채색다보륵초성측량족배동맥혈류속도명현증가(P＜0.01).이식후하지동맥관강혈류유불동정도개선,폐새동맥주위、기육내적측지혈관증다;라선CT혈관조영현시신생측지혈관명현증다.41례환자균미발생병발증화불량반응.제시채색다보륵초성가준 학、쾌속지검측화평개간세포이식후하지혈운개선정황,화혈관조영결과상문합,재평개간세포이식치료당뇨병하지동맥 폐새증적료효방면능위림상제공가고적진단의거.
BACKGROUND:Traditional therapeutic methods of diabetes combined with lower limb artery obturation showed poor outcomes such as drug or intervention.Stem cell transplantation is a new method to treat this disease in recant years,and has obtained good outcomes in the clinic.Evaluating the therapeutic outcomes of stem cell transplantation has great damage and cost much.Thus,color Doppler ultrasound is used to examine non-invasion in the artery of the lower extremity,which shows important clinical value.OBJECTIVE:To evaluate improvement of lower extremity artery lesion following autologous peripheral blood stem cell transplantation using color Doppler ultrasound,and to compare with results of angiography.METHODS:A total of 41 patients diagnosed as having diabetes combined with lower limb artery obturation were included.Following administration of recombinant human granulocyte-colony stimulating factor(rhG-CSF)(150 μg/d)for 5 days,peripheral blood mononuclear cells(PBMNCs)were mobilized and harvested by using a separator at day 5 to prepare stem cell suspension,and which were injected intramuscularly in the diseased extremities(3×109 per limb).The clinical and laboratory findings were monitored every week for 3 months to 1 year following stem cell transplantation.RESULTS AND CONCLUSION:After stem cell transplantation,severe pain lameness,local cool-feeling and ulcer were significantly improved,and ankle-brachial index was increased obviously(P＜0.01).Color Doppler ultrasonography measurement showed that peak systolic velocity in diseased extremities was significantly increased post-transplantation(P＜0.01).Following transplantation,blood flow of the lower limb arterial canal was improved to different extents;collateral vessels were increased surrounding obstructed artery and in muscles.Spiral CT for new collateral vessel formation were showed increased.No related complication or adverse effects were observed in 41 patients during observation.Results indicated that color Doppler ultrasound can exactly rapidly examine and assess blood transport improvement in the lower limbs following stem cell transplantation,which is identical to results from angiography.It also provides reliable evidences for the diagnosis on the transplantation of stem cells for the treatment of diabetes combined with lower limb artery obturation.