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41.
异基因外周血造血干细胞联合骨髓移植治疗重型再生障碍性贫血4例报告 总被引:1,自引:0,他引:1
我院2011年6月至2012年6月对4例确诊的重型和极重型再生障碍性贫血患者进行HLA全相合同胞外周血造血干细胞移植(PBSCT)联合骨髓移植(BMT).移植中患者均未出现严重感染,中性粒细胞及血小板植入时间分别为11~15 d和12~15d,移植后均转变成供者型造血.因此认为从诊断到移植时间短、血制品输注少、预处理个体化以及PBSCT联合BMT是近期移植成功的有利因素. 相似文献
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Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia 总被引:5,自引:0,他引:5
Gu YQ Zhang J Guo LR Qi LX Zhang SW Xu J Li JX Luo T Ji BX Li XF Yu HX Cui SJ Wang ZG 《中华医学杂志(英文版)》2008,121(11):963-967
Background Many treatment options for lower limb ischemia are difficult to apply for the patients with poor arterial outflow or with poor general conditions. The effect of medical treatment alone is far from ideal, especially in patients with diabetic foot. A high level amputation is inevitable in these patients. This study aimed to explore the effect of transplantation of autologous bone marrow mononuclear cells on the treatment of lower limb ischemia and to compare the effect of intra-arterial transplantation with that of intra-muscular transplantation.
Methods In this clinical trial, 32 patients with lower limb ischemia were divided into two groups. Group 1 (16 patients with 18 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-muscular injection into the affected limbs; and group 2 (16 patients with 17 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-arterial injection into the affected limbs. Rest pain, coldness, ankle/brachial index (ABI), claudication, transcutaneous oxygen pressure (tcPO2) and angiography (15 limbs of 14 patients) were evaluated before and after the mononuclear cell transplantation to determine the effect of the treatment.
Results Two patients died from heart failure. The improvement of rest pain was seen in 76.5% (13/17) of group 1 and 93.3% (14/15) of group 2. The improvement of coldness was 100% in both groups. The increase of ABI was 44.4% (8/18) in group 1 and 41.2% (7/17) in group 2. The value of tcPO2 increased to 20 mmHg or more in 20 limbs. Nine of 15 limbs which underwent angiography showed rich collaterals. Limb salvage rate was 83.3% (15/18) in group 1 and 94.1% (16/17) in group 2. There was no statistically significant difference in the effectiveness of the treatment between the two groups.
Conclusions Transplantation of autologous bone marrow mononuclear cells is a simple, safe and effective method for the treatment of lower limb ischemia, 相似文献
Methods In this clinical trial, 32 patients with lower limb ischemia were divided into two groups. Group 1 (16 patients with 18 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-muscular injection into the affected limbs; and group 2 (16 patients with 17 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-arterial injection into the affected limbs. Rest pain, coldness, ankle/brachial index (ABI), claudication, transcutaneous oxygen pressure (tcPO2) and angiography (15 limbs of 14 patients) were evaluated before and after the mononuclear cell transplantation to determine the effect of the treatment.
Results Two patients died from heart failure. The improvement of rest pain was seen in 76.5% (13/17) of group 1 and 93.3% (14/15) of group 2. The improvement of coldness was 100% in both groups. The increase of ABI was 44.4% (8/18) in group 1 and 41.2% (7/17) in group 2. The value of tcPO2 increased to 20 mmHg or more in 20 limbs. Nine of 15 limbs which underwent angiography showed rich collaterals. Limb salvage rate was 83.3% (15/18) in group 1 and 94.1% (16/17) in group 2. There was no statistically significant difference in the effectiveness of the treatment between the two groups.
Conclusions Transplantation of autologous bone marrow mononuclear cells is a simple, safe and effective method for the treatment of lower limb ischemia, 相似文献
44.
目的 探讨新骨的形成在骨髓移植术后2周尤为显著现象的机制。方法 用34只家兔剥除双侧桡骨骨膜3cm,截除剥离骨膜后的桡骨中段1cm,1小时后去除骨缺损区血肿,从股骨大转子处抽取1ml骨髓,随机注入一侧桡骨缺损区作为实侧,另一侧注入等量生理盐水作为对照侧,术后2、4、6、8周分批做放射学、组织学和骨痂中钙、镁、铜含量的检查。结果 骨髓移植有肯定的成骨效果,术后2周实验侧骨痂中镁、铜及术后4周镁含量高于对照侧(P<0.01)。结论 铜和镁在骨髓移植促进骨缺损愈合早期可能具有重要作用,移植术后的2周内补充铜和镁有可能提高骨髓移植的成骨能力。 相似文献
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对1例骨髓移植术后在血型转换中并发重型肝炎的患者,通过人工肝支持系统进行4次血浆置换术,结果患者病情好转出院.提出做好充分的术前准备、加强血型抗体滴度的监测、选取合适血型的血浆,以及术中密切观察患者生命体征变化、预防并发症的发生,术后正确的饮食指导,是保证患者血浆置换术顺利完成的重要措施. 相似文献
47.
目的通过观察菲立磁标记兔骨髓源性神经干细胞(BMSCs)自体移植脊髓后的核磁共振活体示踪及形态,期待找到一种应用非侵袭性方法来识别、跟踪BMSCs的存活状态及与宿主组织整合情况的方法。方法无菌条件下股骨取骨髓,梯度密度离心法分离获取兔骨髓基质细胞;使用“Feridex-多聚赖氨酸复合物(FE-PLL)”标记骨髓基质细胞,采用普鲁士兰染色和台盼蓝排除实验等方法鉴定FE-PLL标记兔骨髓基质细胞的效率和细胞的活力;体外标记的细胞自体脊髓移植,磁共振、免疫组织化学染色和透射电镜检查。结果普鲁士蓝染色显示FE-PLL标记骨髓基质细胞胞质内出现细小的蓝色铁颗粒;与正常未标记的细胞相比较,FE-PLL标记对骨髓基质细胞的活力、增殖和分化等能力没有明显的影响;经菲立磁标记的兔BMSCs自体脊髓移植后,可在核磁共振上活体示踪。结论菲立磁与核磁共振联合可无创性活体标记检测移植的神经干细胞基本的存在部位、存在方式及其一些生物学特性,可以用来活体示踪移植的BMSCs。 相似文献
48.
郭可泉 孟旭 余元龙 韩杰 姜海明 许晓军 陆小军 贾一新 郑俊猛 张海波 李岩 郑铁 许春雷 曾文 王坚刚 崔永强 罗天戈 王珺 Ikehara Susumu 《中华器官移植杂志》2011,32(1)
目的 探讨骨髓移植诱导临床心脏移植后供者特异性免疫耐受的可行性.方法 采取供心的同时采用改良"灌流法"获取供者的骨髓350 ml,经过滤及离心处理后,加入细胞冷冻保护液共80ml,分装于低温冻存袋,经程序降温,置于-80℃冰箱中保存.在常规原位心脏移植术后40 d,取冻存骨髓快速复温,穿刺受者双侧髂后上嵴,立即行骨髓腔内骨髓细胞输注(IBM-BMT),共输注单核细胞1.2×107/kg,CD34+细胞2.38×105/kg.骨髓输注前3 d行预处理,包括应用氟达拉滨、抗胸腺细胞球蛋白及全身淋巴结照射.骨髓移植后静脉应用他克莫司(Tac),维持血Tac浓度谷值在10~20μg/L;3周后改为口服Tac+吗替麦考酚酯(MMF);6周后改为环孢素A及MMF.分别于心脏移植后2、4、8和12周采集受者外周血,分别于术后4、8和12周采集受者的骨髓,应用短串联重复序列-聚合酶链反应法检测供者嵌合体.心脏移植后每周行心肌内心电图检查,每月行心肌活检1次.术后3个月,取受者及第三者外周血单核细胞,行混合淋巴细胞反应(MLR).结果心脏移植后1、2及3个月时受者的外周血及髂骨内骨髓细胞中供者来源的细胞比例分别为26.3%、19.1%、4.8%和46.3%、24.4%、7.6%.IBM-BMT后心肌内心电图监测显示心肌阻抗及R波波幅无明显变化.术后3个月行心内膜心肌活检,未见排斥反应征象.术后3个月时行超声心动图检查,提示心脏舒张、收缩功能良好.MLR提示受者对供者特异性刺激呈现低反应性,而对第三者仍保持良好的免疫活性(P<0.01).结论 采取分期骨髓移植免疫耐受诱导方案可安全、有效地建立嵌合体,成功诱导心脏移植后供者特异性免疫耐受,但远期效果有待进一步研究.Abstract: Objective To investigate a new strategy of bone marrow transplantation (BMT) for donor-specific tolerance induction after heart transplantation. Methods Donor bone marrow cells (BMCs)were harvested simultaneously with donor cardiac graft using modified perfusion method (PM) ,then stored in a -80 ℃ refrigerator after filtration and centrifugation. Whole BMCs (IBM-BMT) (monocytes 1.2 ×107/kg,CD34+ cells 2.38× 105/kg) in host iliac bones were injected into the bone marrow cavity 40 days after heart transplantation. Preconditoning regimens that consisted of fludarabine, antithymoctye globin and total lymphoid irradiation were performed 3 days before BMT. Tacrolimus (Tac) was administrated intravenously after BMT or orally in conjunction with mycophenolate mofetil (MMF) 3 weeks later.Cyclosporine and MMF were orally administrated 6 weeks later. Donor chimerism was detected using short tandem repeats-polymerase chain reaction in monocytes from peripheral blood at the 2nd,4th, 8th or 12th week after BMT or BMCs at the 4th, 8th or 12th week after BMT. Intramyocardium electrocardiography examination or endomyocardial biopsy was performed weekly or monthly respectively. Mixed lymphocyte reactions (MLR) were performed 3 months after BMT. Results Donor chimerism in monocytes in peripheral blood or BMCs in iliac bones measured at the 1 st,2nd and 3rd month after BMT was 26.3%, 19.1%,4.8% ,and 46.3%, 24.4%, 7.6%, respectively. After 3-month follow-up, there was no rejection confirmed by endomyocardial biopsy or intramyocardium electrocardiography. Echocardiography revealed that the diastolic and systolic function of the cardiac graft was maintained well 3 months after BMT. MLR revealed donor-specific hyporesponsiveness while immunocompetence was preserved to third-party antigens. Conclusion These findings indicate that the two-stage BMT strategy is a safe and feasible method for the induction of donor-specific tolerance via stable mixed chimerism and needs to be further confirmed after a long-term observation. 相似文献
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目的 探讨联合成骨细胞移植对骨髓移植小鼠造血功能重建的影响.方法 Balb/c小鼠60只,取其中18只制备移植用骨髓有核细胞和成骨细胞.将其余42只小鼠分为3组.单纯移植组:小鼠18只,仅进行骨髓移植(BMT);联合移植组:18只,进行BMT的同时每只小鼠输入成骨细胞2×106个;正常对照组:小鼠6只,不做任何处理,仅作为移植前的正常对照.移植组小鼠在全身照射(TBI)预处理后4 h经尾静脉注入骨髓细胞2×106个.移植后第7、14和21天,分别处死移植组小鼠6只,对小鼠的外周血细胞和骨髓单个核细胞(BMMNC)进行计数,采用流式细胞术测定BMMNC中CD34+细胞的百分比,使用HPIAS-1000高清晰度彩色病理图像系统测量骨髓造血组织面积,采用免疫组化染色法测定骨髓组织微血管密度(MVD).结果 移植后第7天,单纯移植组和联合移植组小鼠外周血细胞计数及BMMNC数均明显低于正常对照(P<0.01).第21天时联合移植组小鼠白细胞、红细胞及BMMNC数明显恢复,血小板数已接近正常对照组;单纯移植组小鼠外周血细胞数和BMMNC数虽然有所恢复,但其恢复程度明显弱于联合移植组.移植后第7、14和21天,联合移植组外周血细胞计数及BMMNC数均明显高于同期单纯移植组(P<0.01或P<0.05).移植后第7、14、21天,单纯移植组和联合移植组小鼠骨髓造血组织面积、BMMNC中CD34+细胞百分比及骨髓组织MVD均明显低于正常对照组(P<0.01),但联合移植组均高于同期单纯移植组(P<0.01或P<0.05).结论 联合成骨细胞移植能有效促进骨髓移植小鼠骨髓造血系统的重建.Abstract: Objective To explore the effects of cotransplantation with osteoblasts on hematopoietic reconstitution in mice after bone marrow transplantation (BMT). Methods The typical model of syngeneic BMT was established. 18 Balb/c mice were used to prepare the bone marrow nuclear cells and osteoblasts for BMT. The 42 Balb/c mice were randomly divided into 3 group:normal group (6 mice, without any treatment), the single BMT group ( 18 mice, given 2 × 106 bone marrow nuclear cells/each mouse) and the cotransplantation group of HSC with osteoblaats (18 mice,given 2 × 106 bone marrow nuclear cells and osteoblasts/each mouse). The following factors were measured on day 7, 14, 21 after BMT: peripheral blood cells, bone marrow mononuclear cells (BMMNC), the percentage of CD34+ cells in BMMNC (assayed by flow cytometry), the hematopoietic tissue changes (detected by HPIAS-1000 image analysis system) and micro vascular density (MVD) of bone marrow tissue (with immunohistochemistry). Results The levels of periphral WBC, RBC, PLT, BMMNC in the contransplantation group were higher than those in the single BMT group (P<0. 01 or P<0. 05). In the contransplantation group, the percentage of CD34+ cells in BMMNC, the hematopoietic tissue area and the MVD of bone marrow were also higher than the single BMT group on the 7th, 14th, 21st day after BMT(P<0.01 or P<0.05). Conclusion Cotransplantation with osteoblasts could significantly promote hematopoietic reconstruction in mice after BMT. Cotransplantation may represent a promising means of achieving higher engraftment rate after BMT. 相似文献
50.
骨髓细胞经酸性成纤维细胞生长因子孵育后程序移植的实验研究 总被引:2,自引:1,他引:2
目的 充分利用酸性成纤维细胞生长因子(aFGF) 促进造血重建的作用,以进一步完善程序移植新方法。方法 以昆明种小鼠急性放射病为模型,进行了骨髓细胞(BMC) 经自牛脑中制备的aFGF孵育后程序移植对造血重建、急性移植物抗宿生病(GVHD) 的研究。结果 aFGF 孵育后程序移植BMC4 ×106 ,存活率达40% ,比单纯一次移植BMC1 ×107 组高(30% ),但不如单纯骨髓程序移植BMC4 ×106 组(60% );另一方面,外周血白细胞、骨髓有核细胞计数、CFUE、CFUGM、CFUS比一次骨髓移植1×107 组和单纯骨髓程序移植BMC4 ×106 回升快,而CFUF回升无差别;GVHD较一次骨髓移植1 ×107 组轻,较骨髓程序移植4 ×106 重。结论 引起GVHD 的主要原因是异基因T淋巴细胞,通过aFGF孵育后程序移植可以更充分地发挥其促进造血重建的作用,而减轻GVHD。 相似文献