Clinical observation on 36 patients with diabetic peripheral angiopathy after autologous hemopoietic stem cell transplantation / 中国医师进修杂志

ABSTRACT

Objective To observe the clinical effectiveness and prognostic factors of autologous hemopoietie stem cell transplantation on diabetic peripheral angiopathy patients under different degrees of vascular lesions. Methods Thirty-six patients with diabetic were divided into mild vascular stenosis group (group A 20 lower extremities, vascular stenosis less than 50% ), moderate vascular stenosis group(group B26 lower extremities, vascular stenosis of 50%-70% ) and severe vascular stenosis group (group C 25 lower extremities, vascular stenosis greater than 70% ) according to the degree of vascular lesions. All patients were given the stem cell mobilization for 5 days, then peripheral hemopoietic stem cells were gathered on the last day and transplanted to ischemic limb by using monoeyte stem cell suspend liquid with 3 cm × 3 cm intervals.Each index of three groups was regularly observed ( 1th,12th and 18th month respectively after the operation)and comprehensive evaluated. Meanwhile,the transplantation prognostic factors (age, disease duration, post-prandial 2 hours blood glucose, glycated hemoglobin, blood pressure, triglycerides) were analyzed by multiple regression. Results Twelve months after transplantation, the ankle brachial index (ABI) and percutaneous oxygen pressure (TcPO2) of all three groups increased compared with that before the transplantation (P<0.05). In the 18th month after transplantation, the ABI still increased in group A and B (P< 0.05), and no significant changes were found in group C compared with that in the 12th month. Eighteenth month after transplantation, lower extremities of 8 patients (40%) in group A, 8 patients (31%) in group B and 6 patients (24%) in group C were examined to have neovascularizatian. Age, disease duration, blood pressure, post-prandial 2 hours blood glucose, glycated hemoglobin and triglycerides were all the important factors that affected diabetic peripheral angiopathy recurrence after transplantation. Conclusions The long-term effica-cy of stem cell transplantation on diabetic peripheral angiopathy patients at a mild to moderate degree is superior to that with severe vascular lesions. Close monitoring of blood glucose, blood pressure and triglycerides in the operation perinatal stage is required.They are the important prognostic indicators.