The Study On The Clinical Characteristic, The Effect Of Medicine Synthesis Therapy And Umbilical Cord Blood Stem Cell Therapy For Diabetic Foot

Objective:1.To investigate clinical characteristics of diabetic foot and the effect of medicine synthesis therapy.2.Through clinical observation, to explore clinical effectiveness , safety and feasibility of umbilical cord blood stem cell therapy for diabetic foot.Methods:1.According to the diagnosis criteria, inclusion criteria and exclusion criteria of diabetic foot, 88 medical records of diabetic foot in Endocrine Department of the China-Japan Union Hospital of Jilin University from September, 2005 to January, 2010 were collected, all of which used medicine synthesis therapy, to retrospectively analyze the clinical data with sex, age, the duration of disease, Wagner classify method, incentive, predilection site, glycolated hemoglobin A1C, diabetic peripheral neuropathy, peripheral vascular disease, diabetic retinopathy, diabetic kidney disease, high blood pressure, coronary heart disease, cerebrovascular disease and treatment outcome, etc.2.Patients with diabetic foot in Endocrine Department of the China-Japan Union Hospital of Jilin University from May, 2008 to December, 2010 were selected, which were with unsatisfactory therapeutic efficacy of medicine synthesis therapy and agreed to accept umbilical cord blood stem cell transplantation. Umbilical cord blood was collected from the healthy pregnant women that agreed in Obstetrical Department of the China-Japan Union Hospital,and then it was sent to the professional organization to process. Limb was disinfected in the sterile operation, which was treated by multi-point intramuscular injection with 30ml stem cell suspension. The number of stem cell was 1×10~7~10~9/L. The amount was 0.5 ~ 1.0mL each point. The depth was 1.5 ~ 2.0cm. The spacing was between 3cm. To observe limb pain, cold feeling, intermittent claudication, skin color, skin temperature, ulcer and gangrene, adverse events and side effects, etc.3.To analyze the obtained data statistically. Results: 1.The investigation showed that foot problems most frequently occurred in the elderly diabetic patients of more than 70 years old(36.36%) and diabetic duration of 10 - 15 years(38.64%). The blister was main motivation of diabetic foot problems. There were 45.45% ulcers with neuropathy combined with peripheral artery disease. The location of ulcers was mainly toe. 27.27% of the ulcers were at the Wagner stage 4. Most of these Patients had diabetic complications or related lesions, including neuropathy(86.36%), nephropathy(65.90%), hypertension (63.54%), peripheral vascular disease(59.09%) and so on. The therapeutic results of diabetic foot ulcers included cicatrization (16 cases), amelioration (50 cases), amputations (19 cases) and decease (3 cases). All cases of illness convalesce were all from Wagner stage 0 to 3. The total effective rate was 75%. The higher Wagner stage, the more poor treatment effect. The amputation rate was 31.59%, which mainly occurred in Wagner stage 4 and 5.2.5 patients (6 limbs) were treated by umbilical cord blood stem cell transplantation, including 5 of limbs were obviously improved in foot pain, cold feeling and intermittent claudication. The treatment effect of only one limb was not obvious, and the limb was painful significantly. Three months after transplantation , skin colour of foot gradually resolved in 5 of limbs. Foot ulcers began to cure in 4 of limbs. Gangrene wound was decrease, and extremities were preserved in 3 of limbs. One limb eventually had a limb amputations resection. 1 - 3 days after transplantation, some of patients feel the limb swelling and painful, only mild swelling, which had no obvious adverse reaction.Conclusion:1.The investigation showed that foot problems most frequently occurred in the diabetic patients with advanced age, long diabetic duration or more diabetic complications. The effect of medicine synthesis therapy was positive. The total effective rate was 75%. (cicatrization 18.18%, amelioration 56.82%). The effective rate of diabetes foot had a obvious negative correlation with Wagner classify method, for patients of diabetic foot, who should early diagnosed and early treat, and the effect was better.2.The method of umbilical cord blood stem cell transplantation was simple and small traumatic, which could effectively improve diabetic foot in the clinical symptoms and signs, and avoid amputation or reduce amputation plane among some of patients. The short-term curative effect was affirmed. There were no obvious adverse reactions. Because the number of cases and the time of treatment is limited, more comprehensive material need to be collected by further large-scale clinical practice and observing activities.