本文選題：單個核細(xì)胞 + 重度下肢缺血�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2016年博士論文

【摘要】：目的：重度下肢缺血(CLI, critical limb ischemia)是外周動脈疾病的最嚴(yán)重的階段,主要由動脈硬化閉塞癥引起(ASO, atherosclerosis obliterans)。近年來,干細(xì)胞成為治療CLI的研究熱點(diǎn)。該研究的目的是評價自體單個核細(xì)胞治療動脈硬化閉塞癥引起的重度下肢缺血的臨床療效和安全性。方法：分析1998年6月至2014年6月本院71例動脈硬化閉塞癥引起的重度下肢缺血病患者的臨床資料。其中,42人接受自體外周血單個核細(xì)胞(PBMNC, peripheral blood mononuclear cell)治療,作為研究組；29人接受保守治療,作為對照組。通過分析PBMNC組患者治療前與治療1月后疼痛、潰瘍、無痛行走距離的變化情況評價PBMNC治療CLI的短期療效。隨訪兩組患者治療后3年內(nèi)脫離重度下肢缺血(CLI-free, critical limb ischemia-free)、大截肢和死亡的情況,并隨訪3年內(nèi)有無出現(xiàn)PBMNC治療相關(guān)的不良反應(yīng)。結(jié)果：PBMNC治療1個月后,患者疼痛分級明顯降低(P=0.000)、無痛行走距離明顯延長(P=0.012),但潰瘍評分無明顯改善(P=0.317)。PBMNC治療后第3年,患者脫離CLI率是65%,無截肢率是78.7%,總體生存率是75.3%,無截肢死亡率(AFS, amputation free survival)是63.9%。PBMNC組脫離CLI的結(jié)果明顯好于對照組(P=0.011),但兩組無截肢率、總體生存率和無截肢生存率均統(tǒng)計(jì)學(xué)差異(P=0.545,P=0.999,P=0.561)。最嚴(yán)重的不良反應(yīng)是兩名患者在注射PBMNC后分別出現(xiàn)了房顫并發(fā)急性心功能不全和可疑性急性心肌梗死。結(jié)論：PBMNC能緩解患者疼痛、延長無痛行走距離。PBMNC促進(jìn)患者脫離CLI的療效好于對照組,但對總體生存率影響不大。PBMNC對截肢率的影響需要進(jìn)一步驗(yàn)證。治療期間注意預(yù)防冠心病患者心肌缺血癥的發(fā)作。目的：評價自體外周血單個核細(xì)胞(PBMNC, peripheral blood mononuclear cells)治療血栓閉塞脈管炎(TAO, thromboangiitis obliterans)重度下肢缺血(CLI,critical limb ischemia)的臨床療效。方法：收集2004年7月至2013年5月本院22例血栓閉塞性脈炎患者的臨床資料。研究組12例,接受PBMNC治療；對照組10例,接受保守治療。隨訪所有患者治療后2年內(nèi)潰瘍愈合情況、脫離重度下肢缺血(CLI, critical limb ischemia)情況、截肢情況、死亡情況及不良反應(yīng)情況。結(jié)果：研究組的潰瘍愈合情況和脫離CLI情況明顯優(yōu)于對照組(潰瘍愈合：P=0.016,脫離CLI：P=0.013)。研究組和對照組2年截肢率無差異(大截肢：P=0.361,總截肢P=0.867)。2年內(nèi)無死亡病例、無不良反應(yīng)。結(jié)論：與保守治療相比,PBMNC能明顯促進(jìn)TAO患者潰瘍愈合及脫離CLI,但兩者對截肢的影響相同。目的：吸煙與ASO的發(fā)病有密切關(guān)系。該研究是為了評價吸煙在PBMNC治療ASO中對截肢和死亡的影響作用。方法：連續(xù)收集2003年1月至2014年6月應(yīng)用G-CSF動員的自體PBMNC治療的ASO患者52例。分為吸煙組(25人)和非吸煙組(26人),用Log-rank方法對比分析兩組的無截肢率、總體生存率和無截肢生存率；用COX單因素和多因素分析法分析PBMNC治療后截肢和死亡的獨(dú)立影響因素。結(jié)果：吸煙組的截肢率和死亡率高于非吸煙組(P0.05),吸煙組的無截肢生存率低于非吸煙組(P0.05)。截肢的獨(dú)立危險因素有近期吸煙史、Fontanie分期、血紅蛋白和血糖,死亡的獨(dú)立危險因素有吸煙史和年齡。結(jié)論：近期吸煙是影響單個核細(xì)胞治療下肢動脈硬化閉塞癥后截肢和死亡的獨(dú)立危險因素。
[Abstract]:Objective: severe lower limb ischemia (CLI, critical limb ischemia) is the most serious stage of peripheral artery disease, mainly caused by arteriosclerosis obliterans (ASO, atherosclerosis obliterans). In recent years, stem cells have become a research hotspot in the treatment of CLI. The purpose of this study is to evaluate the treatment of arteriosclerosis obliterans by autologous mononuclear cells. Clinical efficacy and safety of severe lower limb ischemia. Methods: the clinical data of 71 patients with severe lower limb ischemia caused by arteriosclerosis obliterans from June 1998 to June 2014 were analyzed. 42 of them received autologous peripheral blood mononuclear cells (PBMNC, peripheral blood mononuclear cell) as the study group; 29 patients received the study. A conservative treatment was used as a control group. The short-term efficacy of PBMNC in the treatment of CLI was evaluated by the changes of pain, ulcer, and painless walking distance in the PBMNC group before and after January. The two groups were followed up for 3 years after treatment with severe lower limb ischemia (CLI-free, critical limb ischemia-free), large amputation and death. In 3 years, there were no adverse reactions associated with PBMNC treatment. Results: after 1 months of PBMNC treatment, the pain classification of the patients decreased significantly (P=0.000) and the painless walking distance was significantly prolonged (P=0.012), but the ulcer score was not significantly improved (P=0.317) after third years of.PBMNC treatment, the rate of disengagement of CLI was 65%, no amputation rate was 78.7%, and the total survival rate was 75.3%, The mortality of amputation without amputation (AFS, amputation free survival) was significantly better than that in the control group (P=0.011), but there was no amputation rate in the two groups, the total survival rate and the amputation survival rate were statistically different (P=0.545, P=0.999, P=0.561). The most serious ungood reaction was the occurrence of atrial fibrillation in two patients after the injection PBMNC. Conclusion: PBMNC can relieve pain and prolong the distance of painless walking distance.PBMNC. The effect of CLI is better than that of the control group, but the effect of.PBMNC on the amputation rate is less than that of the total survival rate. Objective: To evaluate the clinical efficacy of autologous peripheral blood mononuclear cells (PBMNC, peripheral blood mononuclear cells) in the treatment of thrombovasculitis obliterans (TAO, thromboangiitis obliterans) with severe lower limb ischemia (CLI, critical limb ischemia). Methods: 22 cases of thrombotic occlusive vasculitis in our hospital from July 2004 to May 2013 were collected. The clinical data of the patients. 12 cases in the study group were treated with PBMNC, and 10 cases in the control group were treated with conservative treatment. All the patients were followed up for 2 years of ulcer healing, from severe lower limb ischemia (CLI, critical limb ischemia), amputation, death and adverse reactions. Results: the ulcer healing and disengagement of the study group. CLI was significantly better than the control group (ulcer healing: P=0.016, out of CLI:P=0.013). There was no difference in amputation rate between the study group and the control group for 2 years (large amputation: P=0.361, total amputation P=0.867) without death in.2 years. Conclusion: compared with conservative treatment, PBMNC can obviously promote the healing of ulcers and escape CLI in TAO patients, but both of them are amputated. Objective: smoking is closely related to the incidence of ASO. This study was designed to evaluate the effect of smoking on amputation and death in the PBMNC treatment of ASO. Methods: 52 consecutive ASO patients with G-CSF mobilization from January 2003 to June 2014 were collected and divided into smoking group (25) and non smoking group (26), and Log- Rank method was used to compare the amputation rate, total survival rate and no amputation survival rate in two groups. COX single factor and multiple factor analysis were used to analyze the independent factors of amputation and death after PBMNC treatment. Results: the amputation rate and mortality rate of smoking group were higher than that of non smoking group (P0.05), and the survival rate of amputation in smoking group was lower than that of non smoking group (P0.05). Independent risk factors for amputation include the history of smoking in the near future, Fontanie staging, hemoglobin and blood sugar, and the independent risk factors for death are smoking history and age. Conclusion: recent smoking is an independent risk factor for the treatment of amputation and death after the treatment of arteriosclerosis obliterans of lower extremity by mononuclear cells.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R543.5

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王烈;黎成金;;急性下肢缺血性疾病治療方法的選擇[J];中國臨床醫(yī)生;2010年10期

2 趙念博;急性下肢缺血性疾病的介入治療[J];菏澤醫(yī)專學(xué)報(bào);2001年01期

3 向志,時德,戴遠(yuǎn)斌;下肢缺血性疾病導(dǎo)致的截肢[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2001年02期

4 姚燕丹,林少芒,胡以則;自體外周血干細(xì)胞移植治療下肢缺血性疾病的研究進(jìn)展[J];中國醫(yī)藥導(dǎo)刊;2004年06期

5 楊智;沈煥;趙丹丹;段志泉;;因下肢缺血性疾病截肢176例分析[J];中國實(shí)用外科雜志;2007年04期

6 馬英梅;袁淑蘭;馮麗君;;中西醫(yī)結(jié)合治療下肢缺血性疾病體會[J];黑龍江醫(yī)學(xué);2007年06期

7 趙萍;付璐;;9例自體骨髓干細(xì)胞移植治療下肢缺血性疾病的護(hù)理[J];天津護(hù)理;2007年03期

8 張文波;徐欣;;慢性下肢缺血性疾病的診斷進(jìn)展[J];華中醫(yī)學(xué)雜志;2007年03期

9 沈艷霞;張永學(xué);;下肢缺血性疾病的治療現(xiàn)狀[J];國際心血管病雜志;2008年01期

10 楊學(xué)全;楊俊霞;;腰交感神經(jīng)滅活術(shù)治療下肢缺血性疾病[J];西部醫(yī)學(xué);2008年03期

相關(guān)會議論文 前10條

1 姜桂喜;王晉軍;薛智軍;苗進(jìn);;干細(xì)胞移植聯(lián)合中藥治療下肢缺血性疾病[A];2010年中國中西醫(yī)結(jié)合周圍血管疾病學(xué)術(shù)交流會論文集[C];2010年

2 ;骨髓干細(xì)胞移植治療下肢缺血性疾病的研究進(jìn)展[A];2007年浙江省周圍血管外科年會論文匯編[C];2007年

3 黃中柯;樓岑;;干細(xì)胞移植治療下肢缺血性疾病中核素顯像體內(nèi)示蹤的研究[A];中華醫(yī)學(xué)會第九次全國核醫(yī)學(xué)學(xué)術(shù)會議論文摘要匯編[C];2011年

4 范長海;劉瑩;劉艷;隨曉云;楊義國;崔紅隨;梁靜;孫萬才;;“三聯(lián)療法”治療42例慢性下肢缺血性疾病患者臨床效果觀察[A];2010年中國中西醫(yī)結(jié)合周圍血管疾病學(xué)術(shù)交流會論文集[C];2010年

5 孫萬才;范長海;;“三聯(lián)療法”治療42例慢性下肢缺血性疾病患者臨床效果觀察[A];中華中醫(yī)藥學(xué)會周圍血管病分會2010年學(xué)術(shù)大會論文集[C];2010年

6 金畢;孫元;歐陽晨曦;李毅清;胡德英;謝芬;賴傳善;;自體骨髓干細(xì)胞移植治療下肢缺血性疾病的研究[A];中國中西醫(yī)結(jié)合學(xué)會周圍血管疾病專業(yè)委員會周圍血管疾病學(xué)術(shù)會議論文集[C];2007年

7 杜麗蘋;溫志國;李彥州;;外周血干細(xì)胞移植術(shù)治療下肢缺血性疾病102例臨床報(bào)道[A];中華中醫(yī)藥學(xué)會周圍血管病分會第四屆學(xué)術(shù)大會暨中華中醫(yī)藥學(xué)會周圍血管病分會25年會慶論文集[C];2011年

8 艾明瑞;郝琳;于亞娜;;在營衛(wèi)學(xué)說指導(dǎo)下治療下肢缺血性疾病[A];中華中醫(yī)藥學(xué)會周圍血管病分會第四屆學(xué)術(shù)大會暨中華中醫(yī)藥學(xué)會周圍血管病分會25年會慶論文集[C];2011年

9 楊曉鳳;吳雁翔;王紅梅;許憶峰;徐波;呂欣;張軼斌;王法;;自體外周血干細(xì)胞移植治療下肢缺血性疾病臨床及實(shí)驗(yàn)研究[A];第10屆全國實(shí)驗(yàn)血液學(xué)會議論文摘要匯編[C];2005年

10 付贏;;王軍主任診治下肢缺血性疾病經(jīng)驗(yàn)點(diǎn)滴[A];中華中醫(yī)藥學(xué)會周圍血管病分會2010年學(xué)術(shù)大會論文集[C];2010年

相關(guān)重要報(bào)紙文章 前6條

1 柳湘;治療下肢缺血性疾病[N];中國醫(yī)藥報(bào);2003年

2 陳蕾;干細(xì)胞移植與中藥合用治療下肢缺血性疾病[N];中國中醫(yī)藥報(bào);2003年

3 陳蕾;干細(xì)胞移植與中藥合用治療下肢缺血性疾病[N];中國中醫(yī)藥報(bào);2003年

4 劉燕玲;治周圍血管病有新技術(shù)[N];健康報(bào);2003年

5 ;我國干細(xì)胞科研喜訊頻傳[N];人民政協(xié)報(bào);2004年

6 ;脛骨分離再生血管手術(shù)在哈獲成功[N];中國高新技術(shù)產(chǎn)業(yè)導(dǎo)報(bào);2001年

相關(guān)博士學(xué)位論文 前2條

1 付明歡;可顯著提高下肢缺血性疾病干細(xì)胞移植效率的新型細(xì)胞移植體系研究[D];重慶醫(yī)科大學(xué);2015年

2 于靖宜;自體外周血單個核細(xì)胞治療下肢缺血性疾病的臨床研究[D];北京協(xié)和醫(yī)學(xué)院;2016年

相關(guān)碩士學(xué)位論文 前8條

1 徐慶田;284例下肢缺血性疾病（脫疽）的回顧性分析[D];北京中醫(yī)藥大學(xué);2007年

2 王賓;白體骨髓間充質(zhì)干細(xì)胞治療下肢缺血性疾病研究[D];浙江大學(xué);2006年

3 高宗軼;自體骨髓間充質(zhì)干細(xì)胞移植治療下肢缺血性疾病的療效研究[D];山西醫(yī)科大學(xué);2014年

4 李肖娟;自體骨髓干細(xì)胞移植聯(lián)合中藥治療下肢缺血性疾病的30例臨床觀察[D];北京中醫(yī)藥大學(xué);2012年

5 白超;自體骨髓單核細(xì)胞移植治療下肢缺血性疾病的療效觀察[D];新疆醫(yī)科大學(xué);2009年

6 王宏飛;介入療法和外科手術(shù)在治療下肢缺血性疾病中的比較[D];吉林大學(xué);2008年

7 朱曉鋒;下肢缺血性疾病術(shù)后辨證分型回顧性研究[D];廣州中醫(yī)藥大學(xué);2007年

8 付曉瑾;疏肝活血法對下肢缺血性疾病介入術(shù)后再狹窄的臨床研究[D];廣州中醫(yī)藥大學(xué);2014年

，

本文編號：2066931