Long-Term Outcome of Therapeutic Neovascularization Using Peripheral Blood Mononuclear Cells for Limb Ischemia
Long-Term Outcome of Therapeutic Neovascularization Using Peripheral Blood Mononuclear Cells for Limb Ischemia
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DOI：
10.1161/circinterventions.108.799361
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发表时间：
2009-06-01
影响因子：
5.6
通讯作者：
Komuro, Issei
中科院分区：
文献类型：
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作者：
Moriya, Junji;Minamino, Tohru;Komuro, Issei
背景-据报道，注射骨髓单核细胞可有效促进缺血组织的新生血管形成。我们发现外周血单核细胞在治疗动物肢体缺血方面与骨髓单核细胞一样有效，并表明这种治疗对于无选择的肢体缺血患者是可行和安全的。然而，这种治疗的长期结果尚未得到调查。 方法和结果 - 我们使用对数秩检验、Kaplan-Meier 方法和 Cox 比例风险模型回顾性分析了 2002 年 7 月至 2005 年 12 月期间接受治疗的 42 名患者的数据。 60% 至 70% 的患者观察到缺血症状得到改善。通过治疗，年大截肢率显着降低。与非血液透析 ASO 或血栓闭塞性脉管炎患者相比，接受透析的动脉硬化闭塞症 (ASO) 患者的缺血症状改善不太明显。事实上，这些患者的生存率低于非血液透析 ASO 或血栓闭塞性脉管炎患者。死亡、大截肢、心血管事件等主要不良事件大多发生在ASO患者中，且大多数患者正在进行透析。有反应者和无反应者之间的无心血管事件率没有显着差异。年轻应答者的生存率优于无应答者。 结论 - 虽然本研究不是安慰剂对照，并且这些初步结果来自回顾性分析，但注射外周血单核细胞对于治疗肢体缺血可能是安全的且可能有效，但在管理透析的 ASO 患者时需要谨慎。 （Circ Cardiovasc Intervent。2009；2：245-254。）
Background - Injection of bone marrow mononuclear cells has been reported to promote neovascularization of ischemic tissues effectively. We found that peripheral blood mononuclear cells were as efficient as bone marrow mononuclear cells for the treatment of limb ischemia in animals and showed that this treatment was feasible and safe in no-option patients with limb ischemia. However, the long-term outcome of such therapy has not been investigated.Methods and Results - We retrospectively analyzed the data for 42 patients who were treated between July 2002 and December 2005 by using the log-rank test, the Kaplan-Meier method, and the Cox proportional hazard model. Improvement of ischemic symptoms was observed in 60% to 70% of the patients. The annual rate of major amputation was decreased markedly by treatment. Improvement of ischemic symptoms was less marked in arteriosclerosis obliterans (ASO) patients on dialysis compared with nonhemodialysis ASO or thromboangiitis obliterans patients. Indeed, the survival rate of these patients was lower than that of nonhemodialysis ASO or thromboangiitis obliterans patients. Major adverse events such as death, major amputation, and cardiovascular events occurred mostly in ASO patients, and most of them were on dialysis. There was no significant difference in the cardiovascular event-free rate between responders and nonresponders. The survival rate of younger responders was better than that of nonresponders.Conclusions - Although this study was not placebo-controlled and these initial results were from a retrospective analysis, injection of peripheral blood mononuclear cells might be safe and potentially effective for the treatment of limb ischemia, but caution is needed when managing ASO patients on dialysis. (Circ Cardiovasc Intervent. 2009;2:245-254.)