Analysis Of Risk Factors Affecting Early Prognosis Of Autologous Peripheral Blood Mononuclear Cell Transplantation For Severe Lower Limb Ischemia

Objective: Critical limb ischemia(CLI)is a kind of chronic lower limb ischemia caused by various types of endovascular inflammation diseases(such as thromboangiitis vasculitis,lower extremity arteriosclerosis occlusive disease,etc.)The treatment method is mainly divided into surgical treatment and auto-peripheral blood mononuclear cells(auto-PBMNCs)according to the condition of the distal outflow tract of the diseased artery.At present,auto-PBMNCs have proven safety and long-term efficacy for severe lower limb ischemia.However,the study of possible prognostic factors of CLI after auto-PBMNCs transplantation is still insufficient.The purpose of this study was to evaluate possible risk factors for early prognosis of auto-PBMNCs transplantation that affect CLI,and then to guide the clinical identification of high-risk CLI patients as early as possible and take relevant interventions as early as possible to avoid or reduce early postoperative The probability of an adverse event.Methods: The clinical data of 110 patients with CLI who underwent auto-PBMNCs treatment at the Department of Vascular Surgery of the Provincial Hospital Affiliated to Anhui Medical University were collected and retrospectively analyzed.According to the patient’s disease FONTAINE stage ≥ Ⅲ,follow-up time of at least 6 months,and whether the limb pain improved after treatment,the patients were first divided into the pain improvement(maintenance)group and the non-improvement group,and then the patients were divided according to whether amputation was performed.No amputation group and amputation group.The t-test and X2 test were used to analyze the univariate data of the quantitative and qualitative data of the clinical variables in the above different groups,and use the two-class logistic analysis to analyze the above single factors.Finally,determine the variables that may represent the prognostic factors of the CLI after auto-PBMNCs transplant.Results: Of the 110 patients,28 were lost to follow-up,1 died naturally,1 patient developed blood in the stool 2 years after surgery and suspected intestinal tumors,and 1patient had a lymph node biopsy for cough 10 years after surgery to consider the possibility of tumors.The final number of patients eligible for inclusion in the study was 82.Among the patients included in the study,thrombo-occlusive vasculitis(66 cases,80.49%)and arteriosclerotic occlusion(16 cases,19.51%).The average age was45.98 years(range 16-88).The median follow-up time was 36 months.All patients included had an exacerbation rate of 13.41% and an amputation rate of 15.85%.Univariate analysis.The t test in the pain group showed that urea nitrogen(P = 0.01) was statistically significant.Qualitative data analysis between the two groups found that alanine aminotransferase(P = 0.004)was statistically significant.The t test in the group with or without amputation showed that the white blood cells(P = 0.045)and fibrinogen(P = 0.032)before injection were statistically significant.In the test results,the two groups with or without amputation were compared,and it was found that the rate of amputation was higher in patients with high FIB levels.Through the X2 test,fibrinogen> 4 g / L(P = 0.024)was statistically significant.Finally,the above variables were analyzed by using Logistic test,and it was concluded that ALT> 50 IU / L(P =0.003)and fibrinogen> 4g / L(P = 0.013)had significant significance.Conclusion: According to this study,the early risk factors affecting the prognosis of CLI in auto-PBMNCs treatment may be ALT> 50 IU / L and fibrinogen> 4g / L.