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(英文)

Influence Factors for Functional Improvement after Olfactory Ensheathing Cell Transplantation for Chronic Spinal Cord Injury

目的 探讨胚胎嗅鞘细胞（olfactory ensheathing cell，OEC）移植在晚期脊髓损伤（spinal cordinjury，SCI）患者后，影响其功能恢复的因素。方法2001年11月～2003年12月收治晚期SCI患者300例，其中完全性损伤222例，不完全性损伤78例。患者伤后时间为6个月～31年，平均3．1年。手术取胚胎嗅球，消化成单个OEC后培养12～17d。将胚胎OEC移植到SCI部位的上下处。所有患者在胚胎OEC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OEC移植后功能恢复的影响。结果按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提高到45．9±20．3（P〈0．001），轻触觉由术前51．7±24．9提高到63．4±23．0（P〈0．001），痛觉由术前53．0±24．2提高到65．3±22．7（P〈0．001）。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差异无统计学意义。结论胚胎OEC移植能快速帮助晚期SCI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OEC移植后功能恢复的因素。

Objective To explore the influence factors for the functional improvement after the fetal olfactory ensheathing cell （OEC） transplantation for chronic spinal cord injury（SCI）. Methods The olfactory bulbs were harvested and trypsinized down to single fetal OEC. They were cultured for 12-17 days prepared for use. From November 2001 to l）eeember 2003, a total of 300 patients volunteered for the fetal OEC transplantation, among whom 222 suffered from complete chronic SCI and 78 suffered from incomplete chronic SCI. The procedures were performed on the patients with a disease course ranging from 6 months to 31 years （average 3.1 years） after their injuries. The fetal OEC was transplanted by the form of injections into the spinal cord at the upper and lower ends of the injury site. All the patients were assessed by the ASIA standard before the transplantation and 2-8 weeks after the transplantation. The influence factors including age, sex, duration after the injury, and injury degrees and levels were compared with those in the functional improvement after fetal OEC transplantation. Results The partially-improved neurological functions assessed by the ASIA standard were indicated by the motor scores increasing from 39.1±20.6 to 45.9±20.3 （ P 〈 0.001）, the light touch scores from 51.7±24.9 to 63.4±23.0 （ P 〈 0.001）, and the pin prick scores from 53.0±24.2 to 65.3±22.7（ P 〈 0.001）. There was no significant difference in the functional improvement of the motor, light touch, and pin brick when compared with the age, sex, duration after the injury, and the injury degrees and levels. The motor scores and light touch scores at the cervical level were higher than the scores at the thoracic level. Conclusion The fetal OEC transplantation can partially improve the neurological functions quickly in treatment of the chronic spinal cord injury. All the influence factors except the motor scores and light touch scores, which were higher at the cervical level than at thoracic level, have no impact on the functional improvement after the fetal OEC transplantation.