单剂G-CSF动员自体骨髓有核细胞移植治疗糖尿病足
Single dose granulocyte colony stimulating factor-mobilized autologous bone marrow nuclear cell transplantation in treatment of patients with diabetic feet
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摘要: 目的 探讨经单剂粒细胞集落刺激因子(G-CSF)动员后的骨髓有核细胞移植治疗糖尿病足的效果。方法 自2004年5月-2008年2月对解放军总医院第309临床部、徐州市中心医院、河北医科大学第一附属医院、北京市中医医院、河北唐山工人医院的69例糖尿病足患者(69条患肢)随机分组,骨髓组直接采集自体骨髓200mL,单剂G-CSF动员组在采集骨髓前1d给予G-CSF 2μg/kg,采集骨髓100mL,骨髓组采集200mL,分离骨髓有核细胞,检测骨髓有核细胞总数,流式细胞仪检测CD34+细胞百分比,将分离的骨髓有核细胞移植于患者患肢腓肠肌。结果 足部疼痛改善率动员组为89.7%(35/39),骨髓组为90.0%(27/30);两组所有患者在治疗后腿部疼痛均有不同程度改善,动员组1~3d所有患肢(39/39)冷感均有不同程度改善,骨髓组26/30条患肢在1~10d有不同程度改善,两组患者的患肢经皮氧分压均有不同升高。结论 利用单剂G-CSF动员患者骨髓可有效提高骨髓采集物中的有核细胞数量,可减少患者骨髓采集量,不影响糖尿病足疗效。Abstract: Objective To evaluate the efficacy of single dose granulocyte colony stimulating factor(G-CSF)-mobilized autologous bone marrow nuclear cell transplantation in patients with diabetic feet. Methods Patients were randomly divided into test group and control group.Autologous bone marrow was extracted from flank bones of patients after local anesthesia.Patients in test group were given G-CSF(2μg/kg) one day before autologous bone marrow collection and 100mL of autologous bone marrow was collected.Patients in control group did not receive G-CSF and 200mL of autologous bone marrow was collected.Bone marrow was isolated from about 50mL of mononuclear cell suspension and injected into ischemic lower extremity through multipoint muscles.1mL of bone marrow mononuclear cell suspension was injected per point and a 3.0cm×3.0cm interval from one point to another.Autologous bone marrow was collected from the test group.The number of white blood cells and percentage of CD34+ cells were detected. Results The amelioration rate of feet pain was 89.7%(35/39) in the test group and 90.0%(27/30) in the control group,respectively.The amelioration rate of leg pain was 100% in the two groups.Cold sensation of all patients(39/39) in the test group was markedly improved or disappeared 1-3 days after transplantation,and 26 out of 30 patients in the control group 1-10 days after transplantation.The score for transcutaneous oxygen lesion was higher in both groups. Conclusion Diabetic feet can be treated by mobilizaing autologous bone marrow nuclear cells with single dose G-CSF.Single dose G-CSF mobilization can significantly reduce the volume of bone marrow collection.
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