Observation On The Therapeutic Effect Of Autologous Bone Marrow Mononuclear Cell Transplantation In Lower Extremity Vascular Diseases Of Type 2 Diabetes Mellitus

Objective:To study the efficacy and safety of bone marrow mononuclear cells in the treatment of lower limb vascular diseases in type 2 diabetes mellitus.To analyze the effects of different doses of mononuclear cells and different degrees of lower limb vascular lesions in type 2 diabetes mellitus on the therapeutic effects.Methods:A total of 49 patients with type 2 diabetes mellitus complicated with lower extremity vascular disease were selected.The control group was given medical treatment(n=15).The experimental group was treated with bone marrow mononuclear cells(n=34).Evaluation of each group respectively in 0 weeks,12 weeks and 24 weeks whether therapeutic effect(including resting pain score,numbness score,limb cold sensation score,intermittent claudication distance,lower limb skin temperature,percutaneous oxygen partial pressure,ankle-brachial pressure index under resting state)and safety.The patients with type 2 diabetes were divided into superior genicular artery group(n=14)and inferior genicular artery group(n=20).According to different doses of transplantation of bone marrow mononuclear cells will be divided into the low dose group(<5×108,n=11)and high dose group(?5×10~8,n=23).Compared the validity indexes of each group at 0 and 24 week.Results:The symptoms of patients in the bone marrow mononuclear cell group were significantly better than those before treatment(P<0.05).Patients in the control group showed no significant change in symptoms(P>0.05).At 12w,the scores of each subjective index in the bone marrow mononuclear cell group(rest pain,numbness,limb cold sensation score)gradually decreased compared with before(P<0.05),and the distance of intermittent claudication increased compared with before(P<0.05).There was no significant change in the lower limb skin temperature,percutaneous oxygen partial pressure,and ankle brachial pressure index under resting state(P>0.05).At 24w,all the observational indicators in the mononuclear cells group were better than those in the control group(P<0.05),and significantly improved compared with those in the same group at 12w(P<0.05).In the control group,there was no significant change at 24w compared with before treatment(P>0.05).No deaths,malignancies or proliferative retinopathy occurred in the study population during the observation period.At 24 w,knee involvement group and knee artery involvement group of subjective indicators(body rest pain,numbness,cold feeling score)and objective index(intermittent claudication distance,lower limb skin temperature,TcPO2,ABI)than before treatment significantly improved(P<0.05),knee distance during intermittent limp artery involvement group was obviously better than the popliteal artery involvement group(P<0.05),more than all the indicators not obvious difference(P>0.05);Patients in the low-dose group and the high-dose group showed significant improvement in subjective index score and objective index(P<0.05),and the difference between the two groups was not statistically significant at 24w(P>0.05).Conclusion:It is safe and effective that the treatment of lower extremity vascular diseases in type 2 diabetes mellitus by bone marrow mononuclear cells.Therapy of autologous bone marrow mononuclear stem cell was effected by degree of vascular lesions in patient with PAD of T2DM,and which of patient with artery below-knee affected was superior to that of artery above-knee affected.