胚胎嗅鞘细胞移植治疗晚期脊髓损伤影响功能恢复的因素

Influencing factors of functional recovery in patients with spinal cord injury of advanced stage receiving embryonic olfactory ensheathing cellular transplantation

目的:探讨胚胎嗅鞘细胞移植晚期脊髓损伤患者后,影响其功能恢复的因素。方法:①取胚胎嗅球,消化成单个嗅鞘细胞后培养12～17d待用。②选择2001-11/2004-01首都医科大学附属北京朝阳医院和北京西山医院收治的脊髓损伤、志愿接受胚胎嗅鞘细胞移植的患者300例,其中完全性损伤222例,不完全性损伤78例。病程0.5～31年,平均3.1年。将胚胎嗅鞘细胞移植到脊髓损伤部位的上下处。③所有患者在胚胎嗅鞘细胞移植手术前和手术后2～8周按ASIA标准评价和随访,比较年龄、受伤时间、性别、损伤程度和损伤水平对胚胎嗅鞘细胞移植后功能恢复的影响。结果:①按ASIA标准评价神经功能有部分功能快速恢复,其中运动功能由术前(39.1±20.6)分提高到(45.9±20.3)分(P<0.001),轻触觉由术前(51.7±24.9)分提高到(63.4±23.0)分(P<0.001),痛觉由术前(53.0±24.2)分提高到(65.3±22.7)分(P<0.001)。②手术前ASIA级别为A级者222例,术后38例改善为B级,46例为C级。③除损伤水平中颈段运动和轻触觉分数高于胸段外,年龄、受伤时间、性别、损伤程度和损伤水平等因素比较没有显著性差异。结论:胚胎嗅鞘细胞移植能快速帮助晚期脊髓损伤患者恢复部分神经功能,但除损伤水平中颈段运动和轻触觉分数高于胸段外,年龄、受伤时间、性别、损伤程度和损伤水平并不是影响胚胎嗅鞘细胞移植后功能恢复的因素。

AIM： To explore the influencing factors .of functional recovery of patients with spinal cord injury of advanced stage undertaking embryonic olfactory ensheathing cellular transplantation. METHODS： ① Embryonic olfactory bulbs were harvested and cultured for 12-17 days following trypsinized down to single embryonic olfactory ensheathing cells （OECs）. ② 300 patients with spinal cord injury, who received embryonic OECs transplantation voluntarily in the Beijing Xishan Hospital and Affiliated Beijing Zhaoyang Hospital of Beijing Medical University from November 2001 to January 2004 were selected, of which there were 222 patients with complete injury and 78 patients with incomplete injury. The course of disease was 0.5-31 years with an average of 3.1 years. Embryonic OECs were transplanted in the superior and inferior surfaces fo spinal cord injury. ③All patients received assassment and follow-up before and 2-8 weeks after the transplantation by the ASIA standard, and influences of age, time of injury, gender, degree of injury as well as level of injury on functional recovery of embryonic OEC were compared. RESULTS： ①Aeeording to the ASIA standard, neurological functions partially recovered quickly, the score of motor function was enhanced from （39.1±20.6） points to 05.9±20.3） points （P 〈 0.001）; Score of light touch in- creased from （51.7±24.9） points to （63.4±23.0） （P 〈 0.001）; And score of pain sense increased from （53.0±24.2） points to （65.3±22.7） points （P 〈 0.001）.② Of the 222 patients of grade A in ASIA pre-operatively, 38 ones were improved to grade B and 46 ones were improved to grade C post-operatively. ③There were no significant differences in comparison of age, time of injury, gender, degree of injury as well as level of injury, except that,scores of light touch and cervical motor were higher than score of thoracic seg- ments in the level of injury. CONCLUSION： Embryonic OECs transplantation helps some neurological functions in patients with spinal cord injury in advanced period recover quickly, while the age, time of injury, gender, degree of injury as well as level of injury are not influencing factors of functional recovery in embryonic OECs transplantation, except that scores of light touch and cervical motor are higher than score of thoracic segments in the level of injury.