Koshikawa Megumi, Shimodaira Shigetaka, Yoshioka Toru, Kasai Hiroki, Watanabe Noboru, Wada Yuko, Seto Tatsuichiro, Fukui Daisuke, Amano Jun, Ikeda Uichi
Division of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan.
Curr Med Res Opin. 2006 Apr;22(4):793-8. doi: 10.1185/030079906X1000078.
Implantation of bone marrow mononuclear cells (BM-MNCs), including endothelial progenitor cells, into ischemic lower limbs has been shown to improve symptoms in patients with peripheral arterial diseases (PAD). This study investigated whether BM-MNC implantation (BMI) is also effective for the ischemic hands of these patients.
Seven PAD patients with hand ischemia were enrolled: six patients had thromboangiitis obliterans and one had collagen disease. All seven had symptoms involving either resting pain or non-healing ischemic ulcers of the hand. Approximately 600 mL of MNCs were separated from BM and concentrated to a final volume of 40-50 mL, which were injected into ischemic hands. Ischemic status was evaluated by measuring the digital/brachial pressure index (DBI), visual analog pain scale, and the healing of ulcers before and 6 months after BMI.
The mean number of implanted MNCs, CD34-positive cells, and CD34,133-positive cells was 3.67 +/- 0.53 x 10(9), 4.94 +/- 2.45 x 10(7), and 2.52 +/- 1.57 x 10(7), respectively. Mean DBI in those patients was 0.15 +/- 0.30 before BMI and significantly increased to 0.67 +/- 0.19 at 6 months after BMI (p = 0.004). All patients also showed improvement of pain scale and ischemic ulcers. There was no significant correlation between the number of implanted cells and improvement in the degree of DBI or the pain scale.
Autologous BMI could be a promising and safe method of therapeutic angiogenesis for critical hand ischemia in PAD patients.
将包括内皮祖细胞在内的骨髓单个核细胞（BM-MNCs）植入缺血的下肢已被证明可改善外周动脉疾病（PAD）患者的症状。本研究调查了BM-MNC植入（BMI）对这些患者的缺血手部是否也有效。
纳入7例患有手部缺血的PAD患者：6例患有血栓闭塞性脉管炎，1例患有胶原病。所有7例患者均有手部静息痛或缺血性溃疡不愈合等症状。从骨髓中分离出约600 mL单个核细胞并浓缩至最终体积40 - 50 mL，将其注入缺血手部。通过测量指/肱压力指数（DBI）、视觉模拟疼痛量表以及BMI术前和术后6个月溃疡的愈合情况来评估缺血状态。
植入的单个核细胞、CD34阳性细胞和CD34、133阳性细胞的平均数量分别为3.67±0.53×10⁹、4.94±2.45×10⁷和2.52±1.57×10⁷。这些患者术前平均DBI为0.15±0.30，BMI术后6个月显著升至0.67±0.19（p = 0.004）。所有患者的疼痛量表评分和缺血性溃疡也均有改善。植入细胞数量与DBI改善程度或疼痛量表评分之间无显著相关性。
自体BMI可能是一种有前景且安全的治疗性血管生成方法，用于治疗PAD患者严重的手部缺血。
