Clinical Study Of Autologous Peripheral Blood Mononuclear Cells In The Treatment Of Ischemic Diseases Of Lower Extremities

Objective:CLI (critical limb ischemia) represents the most advanced stage of peripheral arterial disease, mainly caused by ASO (atherosclerosis obliterans). Stem cell therapy has been the research hotspot in treating CLI recent years. The aim of this study was to evaluate the clinical effect and safety of autologous G-CSF (Granulocyte Colony Stimulating Factor) mobilized PBMNC (peripheral blood mononuclear cell) in treating CLI caused by ASO.Methods:We retrospectively analyzed the clinical data of 71 patients with CLI caused by ASO from June,1998 to June,2014. The study group (PBMNC group) included 42 patients who were treated with auto-PBMNC, while the control group included 29 patients who received conservative treatment. The short-term effect of PBMNC was evaluated by comparing the improvement of ischemia pain, ulceration and pain-free walking distance before and after treatment. We recorded CLI-free time (critical limb ischemia-free), major amputation time, mortality time and the causes of death of all the patients during 3 years after treatment.Results:1 month after PBMNC therapy, the pain grade was significantly lower (P=0.000), and the pain-free walking distance was obviously longer (P=0.012) compared with those before treatment. But there was no obvious change in ulcer score after treatment (P=0.317). The 3 year CLI-free rate, amputation free rate, overall survival rate, and AFS (amputation free survival) rate were 65%,78.7%,75.3% and 63.9%. The CLI-free rates of patients in PBMNC group were significantly higher than those in the control group. However, there were no difference in amputation free rate, overall survival rate and amputation rate between the two groups (P=0.545, P=0.999, P=0.561). The most serious adverse event were atrial fibrillation complicated with acute cardiac insufficiency and suspected myocardial infarction.Conclusion:PBMNC therapy could relive ischemia and prolong pain-free walking distance. PBMNC had little effect on the survival rate of CLI patients, and its effect on amputation needs further research. Patients with coronary arterial disease should be watched closely during PBMNC therapy.Objective:To evaluate the clinical effect of PBMNC for CLI in thromboangiitis obliterans (TAO) patients.Methods:We retrospectively analyzed the data of 22 patients with CLI caused by TAO from July,2004 to May,2013. The study group included 12 cases who were treated with granulocyte colony-stimulating factor-mobilized PBMNC, and the control group included 10 cases who received conservative treatment. The log-rank test was used to compare the long-term outcomes in PBMNC group and control group.Results:The wound healing rates (P=0.016) and CLI-free rates (P=0.013) were significantly higher in PBMNC group compared with control group. No difference were found in amputation rates between the two groups (major amputation:p=0.361, minor and major amputation:P=0.867). No patients died or no adverse events occurred during the follow-up period.Conclusion:PBMNC therapy could significantly promote wound healing and freedom from CLI in TAO patients, but it does not lower the risk of amputation compared with conservative treatment.Background:Smoking is closely associated with ASO. The aim of this study was to evaluate the prognostic influence of current smoking in autologous peripheral blood mononuclear cell therapy for ASO.Methods:51 consecutive patients with ASO who underwent PBMNC intramuscularly injection from January,2003 to June,2014 were included in a retrospectively cohort analysis. They were divided into smoking group and non-smoking group. Log-rank test was used to compare the amputation free rate, overall survival rate and AFS rate. Cox univariate regression analysis and multivariate regression analysis were used to analyze the independent risk factor for amputation and mortality in ASO patients after PBMNC therapy.Results:The amputation rate and mortality rate was significantly higher in smoking group than in non-smoking group (P<0.05), while the AFS rate was obviously lower in smoking group compared with non-smoking group (P <0.05). The independent risk factors for amputation included current smoking, Fontaine stage, hemoglobin and glucose, and the independent risk factors for mortality included current smoking and age.Conclusion:Current smoking was the independent risk factor for both amputation and mortality in ASO patients after PBMNC therapy.