嗅鞘细胞联合移植干预脊髓损伤的新思考

New insight of intervention of olfactory ensheathing cells transplantation for spinal cord injury

目的:针对嗅鞘细胞及外周嗅神经系统相关细胞的基础生物学特征进行综述,并对可能导致最佳细胞移植干预脊髓损伤效果的特定因素进行深入探讨。资料来源:应用计算机检索Medline1994-01/2004-10关于嗅鞘细胞移植与脊髓损伤的文章,检索词“olfactoryensheathingcell,spinalcordin-jury”,并限定语言种类为English。同时计算机检索万方数据资源系统与中国期刊全文数据库1994-01/2004-10关于嗅鞘细胞移植与脊髓损伤的文章,限定文章语言种类为中文,检索词“嗅鞘细胞,脊髓损伤”。资料选择:对资料进行初审,选取实验包括实验组和对照组的文献,筛除非随机实验的研究,对剩余的文献开始查找全文,进一步判断为随机对照实验。纳入标准为①随机对照实验,采用单盲,双盲或非盲法。②实验包含平行对照组。排除标准:重复性实验研究及综述类文章。资料提炼:共收集到32篇关于嗅鞘细胞干预脊髓损伤的随机实验文章,21个实验符合纳入标准。排除的11篇实验为重复的同一研究和综述。资料综合:21个实验包括脑膜细胞、成纤维细胞、嗅黏膜细胞、胞外基质等联合嗅鞘细胞治疗脊髓损伤的方法,并对各方法给予评价。以上各种联合治疗方法各有特色,但所有的实验结果主要以啮齿类动物-大鼠的脊髓损伤模型为基础而获得的。

OBJECTIVE:To review the basic biology of olfactory ensheathing cells(OECs) and other relevant cells in peripheral olfactory system,and study the factors affected the intervention of cell transplantation on spinal injury.DATA SOURCES:Using the key terms “ olfactory ensheathing cell, spinal cord injury',we searched the MEDLINE database for the articles about cell transplantation of OECs and spinal injury in English,from January 1994 to October 2004.Meanwhile,using the same key terms in Chinese,we searched the Chinese journals full- text database and Wanfang database during the same period.STUDY SELECTION:All articles were selected firstly,those including experimental and control groups were collected.The non- randomized controlled trials were excluded and the rest full text was looked up to get the further judgment.The inclusion criteria:① the randomized controlled trials,single- blind,double- blind and non- blind methods;② experiments including control group. The articles of repetitive studies and summarizations were excluded.DATA EXTRACTION:A total of 32 articles of randomized controlled trial were collected,which were relevant to the olfactory ensheathing cells transplantation strategies for spinal cord injury.22 of them met the inclusive criteria,and the other 11 were excluded because of repetitive studies and summarizations.DATA SYNTHESIS:Twenty- two trials included the methods of meningeal cells, fibroblasts,olfactory mucosa cells and extracelluar matrixes with olfactory ensheathing cells transplantation strategies in treating spinal cord injury.Each trial was assessed. Each trial had special characteristic,but all results were obtained based on models of spinal injury in rats.The collected models included transection of spinal cord, contusion,demyelination,etc.Recently,animal models with spinal injury simulated human could not be obtained.CONCLUSION:No evidence is obtained to prove that appropriate OECs composition can promote the functional restoration after spinal injury. But single and rarefied olfactory ensheathing cells transplantation strategies may not the best choice to treat spinal injury.The important problem is how to choose proper cellular association and how to move from the laboratory to the clinical application in different cell transplantation.