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目的观察自体外周血干细胞移植(peripheral blood stem cell transplantation,PBSCT)治疗重度糖尿病足的临床疗效。方法 50例糖尿病足患者,经下肢动脉CT血管三维重建提示存在严重的下肢血管病变,在内科综合治疗基础上,均自愿接受自体PBSCT术。其中,42例伴有足部溃疡或坏疽,25例因足趾坏疽同时行坏疽趾清除术。同时选择同期入院按常规内科综合治疗(包括控制血糖、血压,抗感染,抗凝,扩血管,局部清创换药等)的糖尿病足病患者50例作为对照。结果自体PBSCT术后随访至6个月,疼痛、冷感、麻木等症状均有改善,术后创面及难愈性溃疡的患者中愈合达到35例(83.33%),无1例发生截肢。与对照组相比,差异有统计学意义(P<0.01)。移植后1月～7年所有患者均未出现并发症和明显不良反应。结论自体PBSCT治疗重度糖尿病足患者有较明显的临床疗效。自体PBSCT治疗糖尿病足是一种安全、有效的手段,促进创面愈合,可使部分患者免除截肢。
Objective To observe the clinical efficacy of peripheral blood stem cell transplantation (PBSCT) in the treatment of severe diabetic foot. Methods Thirty patients with diabetic foot were retrospectively analyzed. Three-dimensional CT reconstruction of the lower extremity artery suggested that there was a serious vascular disease in the lower extremities. On the basis of comprehensive medical treatment, autologous PBSCT was performed voluntarily. Among them, 42 cases accompanied by foot ulcers or gangrene, 25 cases of toe gangrene at the same time necrotizing toe removal. In the meantime, 50 cases of diabetic foot patients who were hospitalized in the same period according to conventional medical comprehensive treatment (including blood glucose, blood pressure, anti-infection, anticoagulant, vasodilator, local debridement, etc.) were selected as controls. Results All the patients were followed up for 6 months after autologous PBSCT. The symptoms such as pain, cold sensation and numbness were improved. Among them, 35 cases (83.33%) healed with wounds and refractory ulcers, none of them had amputation. Compared with the control group, the difference was statistically significant (P <0.01). All patients had no complications and obvious adverse reactions in 1 month to 7 years after transplantation. Conclusion Autologous PBSCT treatment of patients with severe diabetic foot have a more obvious clinical efficacy. Autologous PBSCT treatment of diabetic foot is a safe and effective means to promote wound healing, part of patients can be exempt from amputation.