中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (23): 4539-4362.doi: 10.3969/j.issn.1673-8225.2010.23.040

• 干细胞综述 stem cell review • 上一篇    

自体骨髓间充质干细胞移植治疗严重糖尿病足：1例报告

陈玲珍，陈嘉榆，巫进明，余  卫，詹  昱   

  1. 广州市第十二人民医院血液内科，广东省广州市  510620
  • 出版日期:2010-06-04 发布日期:2010-06-04
  • 作者简介:陈玲珍，女，1971年生，江西省九江市人，汉族，2004年中山大学毕业，硕士，副主任医师，主要从事血液系统疾病及干细胞治疗方面的研究。 yunhe668@ yahoo.com.cn
  • 基金资助:

    广州市医药卫生科技项目(2008-YB-222)

Autologous bone marrow mesenchymal stem cells transplantation for the treatment of severe diabetic foot in one case

Chen Ling-zhen, Chen Jia-yu, Wu Jin-ming, Yu Wei, Zhan Yu   

  1. Department of Hematology, Guangzhou Municipal Twelfth People’s Hospital, Guangzhou  510620, Guangdong Province, China
  • Online:2010-06-04 Published:2010-06-04
  • About author:Chen Ling-zhen, Master, Associate chief physician, Department of Hematology, Guangzhou Municipal Twelfth People’s Hospital, Guangzhou 510620, Guangdong Province, China yunhe668@yahoo. com.cn
  • Supported by:

    the Science and Technology Program of Medical Science of Guangzhou City, No. 2008-YB-222*

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摘要：

背景：研究表明骨髓间充质干细胞在缺血局部可横向分化为血管内皮细胞，并进一步分化形成新生毛细血管，形成新的侧支，改善患者局部血供，从而达到治疗目的，为缺血性下肢血管病的治疗提供了新思路。
目的：观察自体骨髓间充质干细胞移植治疗严重糖尿病足的临床疗效。
方法：选取1例2型糖尿病患者，严重糖尿病足1肢，经下肢动脉CT血管重建提示下肢血管硬化、狭窄和闭塞，抽取患者骨髓液50 mL，密度梯度离心法分离单个核细胞，贴壁细胞培养法分离纯化骨髓间充质干细胞，微生物检测安全后静脉输注给患者。移植后7，30 d，3个月和6个月，以疼痛、冷感、间歇性跛行、踝肱指数、溃疡与坏疽变化等检测指标，观察治疗效果；以彩色多普勒、CT血管三维重建等检测，观察下肢血流改善和动脉侧支重建情况。
结果与结论：3个月后患者疼痛、冷感明显缓解，麻木改善；6个月后疼痛消失，踝肱指数明显升高，溃疡完全愈合，下肢得以保留，行走间距延长，下肢动脉造影CT三维重建及彩色多普勒检查可见患肢有明显的新生侧支血管、血流明显改善。治疗过程中无心、肝、肺、肾等重要脏器功能的损伤，随访患者14个月，未见移植相关并发症。提示自体骨髓间充质干细胞移植为糖尿病足的治疗提供了一条新途径。

关键词: 糖尿病足, 骨髓间充质干细胞, 细胞移植v2型糖尿病, 新生血管

Abstract:

BACKGROUND: Previous studies have shown that bone marrow mesenchymal stem cells (BMSCs) can differentiate into vascular endothelial cells, and then further differentiate into new blood capillary, resulting in forming new collateral branch and in improving blood supply in local site, which can provide new ideas for treatment of ischemic lower extremity disorders.

OBJECTIVE: To observe clinical effects of autologous BMSCs transplantation on the treatment of severe diabetic foot.

METHODS: One patient with type 2 diabetes and severe diabetic foot ulcers was included in this research. BMSCs were isolated and expanded from 50 mL bone marrow aspirates through lower-extremity artery CT vascular reconstruction, which suggested lower-extremity angiosclerosis, stenosis and occlusion. Mononuclear cells were harvested by density gradient centrifugation, and BMSCs were isolated and purified using adherent culture method, and then infused into patients via intravenous infusion following microbiological detection. At 3 and 6 months, 7 and 30 days following transplantation, clinical symptoms such as pain, cold sensation, intermittent claudication, ankle-brachial index (ABI), ulcer area and gangrene were observed. Improvement and blood flow in the lower extremity and artery lateral branch reconstruction were measured by color Doppler flow imaging and CT scan.

RESULTS AND CONCLUSION: At 3 months following transplantation, pain and cold sensation significantly relieved and numbness was improved. At 6 months after transplantation, pain relief was achieved, ABI significantly increased, foot ulcers healed completely, lower extremity was maintained, and foot function in walking was well preserved. New vessels formation was visible and blood flow was significantly improved by color Doppler flow imaging and CT scan. No heart/live/lung/kidney function injury was observed during the transplantation. The patient was followed up for 14 months, no transplantation-related complications were observed. Autologous BMSCs transplantation provides a new way for the therapy of diabetic foot.

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