Dubský Michal, Jirkovská Alexandra, Bem Robert, Nemcová Andrea, Fejfarová Vladimira, Jude Edward B
Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Diabetes Res Clin Pract. 2017 Apr;126:263-271. doi: 10.1016/j.diabres.2017.02.028. Epub 2017 Feb 27.
In this review we report on the state of cell therapy of critical limb ischemia (CLI) with respect to differences between diabetic and non-diabetic patients mainly from the clinical point of view. CLI is the most severe form of peripheral arterial disease and its diagnosis and treatment in diabetic patients is very difficult. The therapeutic effect of standard methods of CLI treatment is only partial - more than one third of diabetic patients are not eligible for standard revascularization; therefore, new therapeutic techniques such as cell therapy have been studied in clinical trials. Presence of CLI in patients with diabetic foot disease is associated with worse clinical outcomes such as lack of healing of foot ulcers, major amputations and premature mortality. A revascularization procedure cannot be successful as the only method in contrast to patients without diabetes, but it must always be part of a complex therapy focused not only on ischemia, but also on treatment of infection, off-loading, metabolic control of diabetes and nutrition, local therapy, etc. Therefore, the main criteria for cell therapy may vary in diabetic patients and non-diabetic persons and results of this treatment method should always be assessed in the context of ensuring comprehensive therapy. This review carries out an analysis of the source of precursor cells, route of administration and brings a brief report of published data with respect to diabetic and non-diabetic patients and our experience with autologous cell therapy of diabetic patients with CLI. Analysis of the studies in terms of diabetes is difficult, because in most of them sub-analysis for diabetic patients is not performed separately. The other problem is that it is not clear if diabetic patients received adequate complex treatment for their foot ulcers which can strongly affect the rate of major amputation as an outcome of CLI treatment.
在本综述中，我们主要从临床角度报告了严重肢体缺血（CLI）细胞治疗在糖尿病患者和非糖尿病患者之间的差异情况。CLI是外周动脉疾病最严重的形式，其在糖尿病患者中的诊断和治疗非常困难。CLI标准治疗方法的治疗效果只是部分有效——超过三分之一的糖尿病患者不符合标准血管重建的条件；因此，诸如细胞治疗等新的治疗技术已在临床试验中进行研究。糖尿病足病患者中CLI的存在与较差的临床结局相关，如足部溃疡不愈合、大截肢和过早死亡。与非糖尿病患者不同，血管重建手术作为唯一方法不可能成功，它必须始终是综合治疗的一部分，这种综合治疗不仅要关注缺血，还要关注感染治疗、减负、糖尿病的代谢控制和营养、局部治疗等。因此，细胞治疗的主要标准在糖尿病患者和非糖尿病患者中可能有所不同，并且这种治疗方法的结果应始终在确保综合治疗的背景下进行评估。本综述对前体细胞来源、给药途径进行了分析，并简要报告了已发表的有关糖尿病患者和非糖尿病患者的数据以及我们对CLI糖尿病患者进行自体细胞治疗的经验。从糖尿病角度对这些研究进行分析很困难，因为大多数研究中未对糖尿病患者进行单独的亚分析。另一个问题是，目前尚不清楚糖尿病患者是否接受了针对其足部溃疡的充分综合治疗，而这可能会严重影响作为CLI治疗结果的大截肢率。
