Procházka V, Gumulec J, Jalůvka F, Salounová D, Jonszta T, Czerný D, Krajča J, Urbanec R, Klement P, Martinek J, Klement G L
Radiodiagnostic Institute, University Hospital Ostrava, Ostrava-Poruba, Czech Republic.
Cell Transplant. 2010;19(11):1413-24. doi: 10.3727/096368910X514170. Epub 2010 Jun 7.
Fifty percent of diabetics (7% of general population) suffer from peripheral arterial occlusive disease, which may lead to amputation due to critical limb ischemia (CLI). The aim of our study was to prevent major limb amputation (MLA) in this group of patients using a local application of autologous bone marrow stem cells (ABMSC) concentrate. A total of 96 patients with CLI and foot ulcer (FU) were randomized into groups I and II. Patients in group I (n = 42, 36 males, 6 females, 66.2 ± 10.6 years) underwent local treatment with ABMSC while those in group II (n = 54, control, 42 males, 12 females, 64.1 ± 8.6 years) received standard medical care. The frequency of major limb amputation in groups I and II was 21% and 44% within the 120 days of follow up, respectively (p < 0.05). Only in salvaged limbs of group I both toe pressure and toe brachial index increased (from 22.66 ± 5.32 to 25.63 ± 4.75 mmHg and from 0.14 ± 0.03 to 0.17 ± 0.03, respectively, mean ± SEM). The CD34(+) cell counts in bone marrow concentrate (BMC) decreased (correlation, p = 0.024) with age, even though there was no correlation between age and healing. An unexpected finding was made of relative, bone marrow lymphopenia in the initial bone marrow concentrates in patients who failed ABMSC therapy (21% of MLA). This difference was statistically significant (p < 0.040). We conclude ABMSC therapy results in 79% limb salvage in patients suffering from CLI and FU. In the remaining 21% lymphopenia and thrombocytopenia were identified as potential causative factors, suggesting that at least a partial correction with platelet supplementation may be beneficial.
50%的糖尿病患者（占普通人群的7%）患有外周动脉闭塞性疾病，这可能会因严重肢体缺血（CLI）导致截肢。我们研究的目的是通过局部应用自体骨髓干细胞（ABMSC）浓缩物来预防该组患者的大肢体截肢（MLA）。共有96例CLI和足部溃疡（FU）患者被随机分为I组和II组。I组患者（n = 42，男36例，女6例，66.2±10.6岁）接受ABMSC局部治疗，而II组患者（n = 54，对照组，男42例，女12例，64.1±8.6岁）接受标准医疗护理。在随访的120天内，I组和II组的大肢体截肢频率分别为21%和44%（p < 0.05）。仅在I组挽救的肢体中，趾压和趾臂指数均增加（分别从22.66±5.32 mmHg增至25.63±4.75 mmHg，从0.14±0.03增至0.17±0.03，均值±标准误）。骨髓浓缩物（BMC）中的CD34(+)细胞计数随年龄下降（相关性，p = 0.024），尽管年龄与愈合之间无相关性。一个意外发现是，ABMSC治疗失败的患者（MLA患者的21%）初始骨髓浓缩物中存在相对的骨髓淋巴细胞减少。这种差异具有统计学意义（p < 0.040）。我们得出结论，ABMSC治疗可使CLI和FU患者的肢体挽救率达到79%。在其余21%的患者中，淋巴细胞减少和血小板减少被确定为潜在病因，这表明至少部分补充血小板可能有益。
