| Background and Objective:Diabetic foot is a serious syndrome of diabetes. According to the incidence of diabetes increasing, diabetic foot has been attracted great importance to. DF belongs to ischaemic diseases. DF always invade many segment of artery. The degree of straitness is very serious. The ischaemic pathological changes happen in the far crura. The effect of clinic routine medicine is worse. Moreover DF patients are not candidates for nonsurgical or surgical revascularisation.The number of the DF disabled are huge. A large number of diabetic patients die of DF. With the understand of stem cell biological characteristic and research developing, recently the useness of stem cell in therapeutic angiogenesis is becoming the focus in medicine ,biology and so on. The experiment result showed bone marrow stem cells could induce vasculogenesis after they were transplanted into ischaemic limbs.The result also indicated that the stem cells transplantation participated in collateral vessel formation. Based on this, we evaluatedefficacy and safety of autologous transplantation of bone marrow stem cells in patients with ischaemic limbs because of diabetic foot.At the same time, to investigate the simple ^ economic and available ways in stem cell transplantation for DF treatment, we carried through the clinical research about it. Objects and Methods:28 patients of bilateral diabetic feet qualified for bone marrow stem cell transplantation if they had chronic limb ischaemia, including severe pain lameness,local cool-feeling, intermittent limping, skin temperature , non-healing ischaemic ulcers, ankle-brachial index and digital subtraction arteriography. Control these candidates' limosis blood glucose^7.0mmol/L, non-limosis blood glucose^ lO.Ommol/L .After obtained written informed consent from all patients, ?28 patients with unilateral ischaemia of the leg (28 legs ) were injected with bone morrow stem cells into the gastrocnemius of the ischaemic limb as a treatment group. After aspirating of 250-300ml of bone marrow blood from the ilium, the mononuclear cells were seperated and the injected into the muscles . In the treatment room , sterilize air 30 minutes, inject pethidine hydrochloride injection lOOmg to alleviate pain before transplantation. Under the asepsis operation, inject liquid contained stem cells into ischaemia gastrocnemius for transplantation. Every site 0.75-lml/limb, 0.5ml/foot; the deep: 1.5-2cm/limb> 0.5-lcm/foot;the distance between twe site: 3cm X3cm/limb, 2cm X 2cm/foot. There were about 50-60 sites. ? The other ischaemic limb of 28 patients without any treatment as a control. The clinical and laboratory findings were monitored for at least 3 months . Statistical analysis. Changes in variables from baseline to 3 months and differences between active and control treatment were analysed with paired t test with SPSS10.0 software package. All P values were two-tailed; 95% C/s were calculated for differences. Results:?There were (0.8-5.2) X109 bone marrow mononuclear cells in the treatment group.Bone marrow mononuclear cells contained (0.4-1.9) X 107 CD3/.Aftertransplantation, there were significant differences in the treatment group.The color of skin, severe pain lameness,local cool-feeling, intermittent limping, skin temperature and ulcer all had improved. Ankle-brachial index also had progressed. Digital subtraction arteriography showed that new collateral vessel formation was most clearly visible. Severe pain lameness ,local cool-feeling, intermittent limping, skin temperature , ankle-brachial index and digital subtraction arteriography. Assessment was significantly respective improved from (3.00±0.93), (3.07+1.10), (3.47+1.13), (30.29+ 0.98), (0.37 + 0.18), (2.23 + 0.93) to (0.67 + 0.72), (0.67 + 0.90), (1.07 + 1.39), (31.56+0.99), (0.66+0.09), (1.31 ±0.48) in legs injected with bone marrow stem cells. There were statistical meanings (P<0.05) o?There were not significant changes in the control group. Every index of symptom and laboratory before and after injection had no signidicant meaning (P>0.05) .(3)The effect in the treatment group was superior to the control one. Severe pain lameness ,local cool-feeling, intermittent limping, skin temperature , ankle-brachial index and digital subtraction arteriography assessment respective as (-2.33 + 0.98) , (-2.40+1.18), (-2.40+1.40), (1.27 + 0.41), (0.15±0.06), (0.92+1.04) in the treatment group compared with those assessment as (0.00+0.38), (0.07 + 0.46), (0.03 + 0.29), (0.00 + 0.02), (0.00 + 0.41) in the control one had statistical meanings (P<0.05).?No other related complication or adverse effect were observed during the 3-month and much longer period observation except edema in the treatment limb during transplantation 3-5 days. Conclusion:1. Autologous transplatation of bone marrow stem cells could be a safe and effective strategy for treating patients with diabetic feet.2. The method of injecting pethidine hydrochloride injection lOOmg to alleviate painbefore transplantation under the asepsis circumstance in the treatment room is safe,effective, simple and economic. This method is much more characteristic inhumanity. It deserve popularization. 3. How to optimize the transplantation effect after bone marrow stem celltransplantation into DF patient need we continue practising. The long term effect oftransplantation need we continue observing.
|
PDF Full Text Request