[A clinical study on implantation of autologous bone marrow mononuclear cells after bone marrow stimulation for treatment of lower limb ischemia].
摘要
OBJECTIVE: To observe the clinical efficiency of the implantation of the autologous bone marrow mononuclear cells for treatment of lower limb ischemia after the bone marrow stimulation. METHODS: From May to December 2005, 43 ischemic limbs in 35 patients (23 males, 12 females; aged 34-90 years,averaged 71.3 year) were treated. Of the 35 patients, 30 had diabetic lower limb ischemia with 38 lower ischemic limbs, 2 had atherosclerosis obliterans with 2 ischemic lower limbs, and 3 had thromboangiitis obliterans with 3 ischemic lower limbs. Five patients with 5 ischemic limbs were in stage I lower limb ischemia (intermittent claudication), 15 patients with ischemic 19 limbs were in stage II (rest pain), 9 patients with 12 ischemic limbs were in stage IIIa (ulceration), and 6 patients with 7 ischemic lower limbs in stage IIIb (gangrene); 88.4% of all the ischemic lower limbs (38/43)had a pain, 79.1% (34/ 43) had coldness, and 69.8% (30/43) had limb numbness. The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte-macrophage colony-stimulatory factor (GSF), 300 microg/d for 2-3 days. The bone marrow 130-200 ml was drawn from the iliac spine and the mononuclear cells were obtained. Each patient received implantation of the autologous bone marrow mononuclear cells by an intramuscular injection, an arterial intraluminal injection or a combined injection of the two routes. RESULTS: The pain relief was found in 94.7% of the ischemic lower limbs, and pain improvement in 97.1% . Relieved numbness was found in 93.3%. The distance of the claudication was increased by all the ischemic limbs. An increase in the ankle/ brachial index (ABI) was found in 47.9%. The transcutaneous oxygen pressure (TcPO2) increased in 92.3%. The ulcer heal rate was 9.1% (1/11). Markedly-reduced ulcer wound was found in 27.3% (3/11). The amputation rate was 6.3% (3/48). Arterial angiography revealed that there was a new collateral vessel formation in 91.2%. Comp