关键词: 糖尿病足, 自体外周血, 干细胞, 移植, 自体外周细胞, 动员

Abstract:

BACKGROUND: Conventional therapeutic methods for vascular lesion in the lower limb following diabetes and for diabetic foot include drug, intervention or surgery. If severe, amputation is needed, which significantly affects quality of life of patients. Therapeutic vascularization is a new technique that has widely developed all over the world.
OBJECTIVE: To evaluate the efficacy of autologous peripheral blood stem cell transplantation for treating patients with diabetic foot.
METHODS: A total of 30 patients with diabetic foot, who had been treated with medicines of reducing blood sugar and of improving microcirculation and expanding blood vessels, resulting in a poor outcome, were included at the Department of Combined Therapy, Second Affiliated Hospital (North District), Dalian Medical University. There were 16 males and 14 females, aged 46-72 years, including 14 cases of lesion in both lower extremities and 16 cases of lesion in single extremity. A total of 44 cases had affected feet. The courses of diabetes were from 3-7 years. Of them, 5 cases were advised to receive amputation in other hospitals. All patients underwent autologous peripheral cell mobilization. When reached standards, autologous stem cell suspension was collected. Local injection was performed in ipsilateral leg muscles of affected feet. At the same time, E1 Dingle and manyprickle acanthopanax root were infused into patients. Ulceration dressings was regularly replaced and debrided. After successful transplantation, the temperature of skin, the feeling of foot, ulceration and gangrene, adverse effects were observed.
RESULTS AND CONCLUSION: Among initial 30 patients with diabetic foot, 1 patient died of cardio-cerebrovascular disease during follow-up, so 29 patients were included in the final analysis. All cases were followed up for 6 months. At 7-14 days following peripheral blood stem cell transplantation, pain significantly relieved in 30 patients (44 feet). Percutaneous oxygen pressure and skin temperature were obviously increased in injured feet. Feeling in feet was markedly enhanced. 1-6 weeks later, infection was controlled. 12-16 weeks later, gangrene in the ulcer region was obviously improved in 29 patients, with new granulation tissue. 6 months later, 4 patients were completely healed. During mobilization, 15 patients felt skeleton and muscular soreness. At 5 days following transplantation, foot and leg muscle were slightly swollen and ached. Above-mentioned results indicated that autologous peripheral blood stem cell transplantation can effectively increase blood flow of the lower extremity, improve ulcer healing, avoid amputation, and improve the living quality of patient.