Quality of life improvement and long-term effects of peripheral blood mononuclear cell transplantation for severe arteriosclerosis obliterans in diabetic patients on dialysis
Quality of life improvement and long-term effects of peripheral blood mononuclear cell transplantation for severe arteriosclerosis obliterans in diabetic patients on dialysis
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DOI：
10.1253/circj.71.1193
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发表时间：
2007-08-01
影响因子：
3.3
通讯作者：
Takaichi, Kenmel
中科院分区：
文献类型：
--
作者：
Hoshino, Junichi;Ubara, Yoshifumi;Takaichi, Kenmel
严重动脉硬化闭塞症（阿索）是一种顽固性疾病，尤其是在接受血液透析（HD）的糖尿病患者中。最近，已报道自体外周血单核细胞（PBMNCs）的移植具有有益效果，方法与结果7例糖尿病合并严重阿索硬化闭塞症的HD患者接受自体外周血单个核细胞移植，观察移植后的远期疗效及对生活质量的影响（方丹IV组5例，方丹III组2例）给予5 μ g/kg粒细胞集落刺激因子后;通过测量皮肤温度、皮肤灌注压（SPP）、踝臂指数（ABI）和溃疡大小以及血管造影结果评估QOL和缺血程度。术后4周，皮肤温度明显改善，SPP和ABI也有所增加。这些有益效果持续长达24周。7例患者中3例血管造影结果和4例患者中3例溃疡大小分别改善。SF-36 v2分析显示疼痛评分显著改善。结论外周血单个核细胞移植可明显改善患者疼痛和下肢缺血症状，随访6个月以上，无严重并发症发生。该疗法对HD糖尿病患者的重度阿索安全有效。
Background Severe arteriosclerosis obliterans (ASO) can be intractable, especially in diabetic patients on hemodialysis (HD). Recently, the transplantation of autologous peripheral blood mononuclear cells (PBMNCs) has been reported to have beneficial effects, but the long-term effects and impact on quality of life (QOL) have not been studied.Methods and Results Autologous PBMNCs were transplanted into 7 diabetic patients on HD who had severe ASO (5 cases with Fontaine IV and 2 with Fontaine III) after administration of 5 mu g/kg granulocyte colony stimulating factor; QOL and degree of ischemia was assessed by measuring skin temperature, skin perfusion pressure (SPP), ankle-brachial index (ABI), and ulcer size, and from angiographic findings. At 4 weeks after the procedure, skin temperature was significantly improved, and SPP and ABI also were increased. These beneficial effects persisted for up to 24 weeks. Angiographic findings and ulcer size improved in 3 of 7 and 3 of 4 patients, respectively. SF-36v2 analysis revealed significant improvements in pain scores. No serious complications were detected.Conclusion Transplantation of PBMNCs resulted in improvement in pain and leg ischemia for over 6 months without serious complications. This therapy is safe and effective for severe ASO in diabetic patients on HD.