Study Of The Implantation Of Autologous Bone Marrow Stem Cells In The Treatment Of Chronically Ischemic Disease Of Lower Extremity

Objective: To probe into the application of autologous bone marrow stem cells transplantation in the treatment of chronically ischemic disease of lower extremity and evaluate the security and curative effect.Secondly, to probe into the difference of curative effect between Intramuscular transplantation and Endovascular transplantation.Methods: 40 patients with chronically ischemic lower limb had been treated since January 2008 to June 2009. Among them, 32 males, 8 females; aged 31~87 years, averaged (68.2±7.1) years. Of the 40 patients, 21 diagnose atherosclerosis obliterans, 15 diagnose diabetic foot and 4 diagnose thromboangiitis obliterans. 37 had pain symptom, 39 had cold symptom, 29 had numbness symptom , 23 had ulcer symptom, 40 had intermittent claudication symptom. 6 patients were in FontaineⅡ, 11 patients were in FontaineⅢ, 23 patients were in FontaineⅣ. All patients had been defeated from standard medicamentous cure. By difference of transplantation means, divided equally 40 patients into Intramuscular transplantation group (the first group) and Endovascular transplantation group (the second group). The fasting blood glucose of diabetic must be controlled below 7.0mmol/L, and the non-fasting blood glucose must be controlled below 10.0mmol/L, and the HbAlc must be controlled below 6.5%. The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte macrophage colony-stimulatory factor(G-CSF), 300μg/d, for 2～3days. Upon completion of stimulation, the bone marrow 200ml was drawn from the iliac spine and the stem cells were obtained, after disassociated and depuated, transplanting into the more severely ischemic limb. Antiplatelet therapy and Vasodilator therapy must be continued, and they were followed once a month after the transplantation. The skin temperature, transcutaneous oxygen pressure(TcPO2), digital subtraction angiography(DSA)and ankle/brachia index (ABI) were rechecked at 6 months later, and the symptoms of pain, cold, numbness, intermittent claudication and physical signs of ulcer and gangrene were evaluated. SPSS16.0 statistical software were used for datum processing. The curative effect before and after treatment were compared using paired t-test. The curative effect between two groups were compared using Variance-test. Test level as :ɑ=0.05.Results: Six months later, all of 40 patients were involved in the analysis of result. The indexes of the two groups of auxiliary examination and clinical symptoms before and after treatment had statistical significance((P<0.01) (table 1, table 2, chart 2). Among them, 4 patients had rich Collateral Circulation (image2.1.1~2.1.4), and 3 patients had ulcer healing well after transplantation (image2.2.1~2.2.3 ). The total effective rate of clinical symptoms and Collateral Circulation of two groups are larger than 60%(table 3, chart 1). ABI before and after treatment are all no statistical significance (P>0.05)(table 1). All of the indexes are no significant difference between the two groups((P>0.05))(table 4).Conclusion: transplantation of autologous bone marrow stem cells is effective in the treatment of chronically ischemic disease of lower limb. which is a simple, safe and effective treatment for chronically ischemic disease of lower limb. There is no significant difference of curative effect between Intramuscular transplantation and Endovascular transplantation. The mobilization stimulated bone marrow stem cells transplantation has advantages of taken a less bone marrow, obtained a larger amount cells and had a high security.