摘要
目的观察置管溶栓联合自体外周血干细胞移植治疗血栓闭塞性脉管炎(TAO)的疗效。方法回顾性分析昆明医科大学第四附属医院血管外科2009年4月至2013年4月期间收治的64例TAO患者(68条患肢),随机均分为两组,其中32例行置管溶栓联合自体外周血干细胞移植术(A组),32例单纯采用自体外周血干细胞移植术(B组),采用主观指标包括患肢疼痛、冷感以及客观指标包括跛行距离、踝肱指数、足部溃疡变化、皮温、截肢率进行疗效评价。采用t检验和c2检验分析两组疗效指标的差异。结果移植1个月后,两组64例患者(68条患肢)小腿疼痛均不同程度缓解,小腿冷、凉感觉消失;干细胞移植3个月后,A、B组两组间歇性跛行距离[(311.24±124.56)m,220.38±45.53)m,t=6.01,P=0.01],下肢皮温[(30.29±0.42)℃,(29.50±0.46)℃,t=28.05,P=0.00]、ABI(0.64±0.02,0.51±0.02,t=26.00,P=0.00)差异均具有统计学意义。A组中2例(2条患肢),B组中4例(4条患肢)术后3个月由于小腿中段以下出现坏死导致膝下截肢,截肢率A组为:5.9﹪(2/34);B组为:11.8﹪(4/34);所有患者经肿瘤标记物、B超或CTA检查,均未发现恶性肿瘤、视网膜增生、动脉瘤等并发症。结论置管溶栓联合自体外周血干细胞移植治疗TAO是一种可供选择的新的治疗途径。
Objective To investigate the efficiency and safety of catheter-directed thrombolysis combined with autologous peripheral blood stem cell transplantation for the treatment of thromboangiitis obliterans. Methods Among 64 patients （68 lower limbs） with thromboangiitis obliterans, 32 cases were treated by catheter-directed thrombolysis combined with autologous peripheral blood stem cell transplantation （A group）. The other 32 cases were only treated by autologous peripheral blood stem cell transplantation （B group）. A series of subjective indexes （improvement of pain and cold sensation） and objective indexes including increase of Claudication distance, ankle brachial index （ABI）, skin temperature, improvement of foot skin ulcer and amputation rate were compared between the 2 groups. Results One month after the treatments, pain, cold and cool feelings in lower limbs relieved in both groups. Three months after transplantation, group A was superior to group B in terms of the distance of [（311.24±124.56） m, 220.38 ＋ 45.53 ） m, t = 6.01, P = 0.01 ], skin temperature[ （30.29 ±0.42） ℃, （29.50 ±0.46）℃, t = 28.05, P = 0.00] and ankle-brachial index （0.64 ±0.02, 0.51 ±0.02, t = 26.00, P = 0.00）. The differences were statistically significant.. Due to necrosis in middle and lower parts of leg, 2 patients in group A and 4 patients in group B received extremity amputation after 3 months of the treatment. The amputation rate were 5.9 % （2/34） in group A and 11.8 % （4/34） in group B. Cancer, retina hyperplasia and aneurysm were not found in all patients as shown by tumor marker assay, ultrasound and CTA. Conclusion Catheter-directed thrombolysis combined with transplantation of autologous peripheral blood stem cells is an effective therapy.
出处
《中华细胞与干细胞杂志（电子版）》
2014年第3期1-5,共5页
Chinese Journal of Cell and Stem Cell（Electronic Edition）
基金
云南省自然科学基金(2010ZC219
2011FB150)
云南省学术与技术带头人后备人才基金(2008PY004)
关键词
移植
自体
外周血干细胞移植
下肢
缺血
血栓性脉管炎
闭塞性
Transplantation, Autologous
Peripheral blood stem cell Transplantation
Lower extremity, Ischemia
Thromboangiitis obliterans
