| OBJCTIVE To estimate the clinical efficiency of implantation of the autologous bone marrow mononuclear cells combined with traditional Chinese medicine (TCM) for treatment of lower limb ischemia.METHODS The subjects were diagnosed with the lower limbs of30cases (46limbs) in January2010to December2011cases, and were treated by autologous bone marrow stem cell transplantation in our department.30patients (46limbs) were randomly divided into the transplantation group (group A) and transplantation+TCM group (group B),15cases in each group. Of group A,14males,1female; aged33to82years, averaged59.13±17.90; course of6months to15years, an average of7.03±4.40years.Of group B,12males,3females; aged40to77years, an average of59.40±16.39; course of3months to10years, an average of6.02±3.75. The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte-macrophage colony-stimulatory factor (GSF),300microg/d for2-3days.200-300ml bone marrow blood was drawn from the iliac spine and the mononuclear cells were obtained. Bone marrow mononuclear cells were isolated and purified by density gradient centrifugation.Then, the cell suspension was transplanted to the limb gastrocnemius site by an intramuscular injection.Group B patients were treated with a decoction of Chinese medicine after the implantation of the autologous bone marrow mononuclear cells. The symptoms of pain, cold sensation, numbness, intermittent claudication, ulcer score and ABI before and after treatment were evaluated in order to the clinical effect.SPSS18.0statistical software was used to analysis data.RESULTS Among group A of15patients (22limbs) after the treatment, none limb was cured,2(9.1%) limbs were improved remarkabled,16(72.7%) limbs were effective, and4(18.2%) limbs were noneffective, the total effective rate was81.8%;15patients (24limbs) after the treatment in group B,1(4.2%) limb was cured,8(33.3%)limbs were markedly-effective,13(54.2%) limbs were effective,2(8.3%) limbs were invalid,the total effective rate was found in91.7%. The two groups can effectively alleviate the clinical symptoms of lower limb ischemia.By contrasting the overall effect of two sets, the difference had statistically significant effect (P<0.05), group B preceded group A. The total effective rates of pain improvement between group A and B were86.4%(19/22) and95.7%(22/23). The total effective rates of cold sensation in A and B were81.8%(18/22) and87.5%(21/24) respectively. The total effective rate of numbness in group A was50%(8/16);the same in group B was56.3%(9/16).The overall efficacy of intermittent claudication in group A and group B reached70%(7/10) and80%(8/10).The ulcers heal or reduced rate of group A and B were66.7%and71.4%respectively. An increase in the ankle/brachial index (ABI) was found in47.9%in group A and it was75%in group B.Before and after the therapy both A and B, the observed indicators had all improved (P<0.05). Compared with Group A after the treatment, pain in group B improved significantly (P<0.01), and, ABI and sense of coldness improved had a statistically significant difference (P<0.05). The numbness and intermittent claudication of group B compared with Group A after operation, despite the increase, but the difference was not statistically significant (P>0.05).CONCLUSION Stem cell transplantation for treatment of lower extremity ischemic disease can effectively relieve clinical symptoms.Plus the traditional Chinese medicine, they can improve the clinical efficacy of stem cell transplantation, suggesting that traditional Chinese medicine paly a role in promoting the improvement of local circulation in ischemic limbs after bone marrow stem cell transplantation. Autologous bone marrow stem cell transplantation combined with traditional Chinese is an effective treatment for lower limb ischemia.The long-term effect of this method needs a further study. |
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