自体骨髓间充质干细胞治疗脊髓损伤疗效观察

Curative effect of autologous mesenchymal stem cell transplantation on spinal cord injury

目的:观察自体骨髓间充质干细胞移植治疗脊髓损伤患者的近期疗效及其安全性。方法:选择2005-04/2006-02在山东省残疾人康复中心住院的脊髓损伤患者24例,采用随机表法分为治疗组和对照组。患者知情同意并签署知情同意书。治疗组11例,对照组13例,均经CT或MRI确诊并行手术治疗。两组在年龄、病程、损伤程度(ASIA分级)等方面均具有可比性(P>0.05)。治疗组在综合康复治疗的基础上给予自体骨髓间充质干细胞治疗,经髂骨穿刺采集自体骨髓156～180mL,分离提取骨髓间充质干细胞后经静脉途径和/或蛛网膜下腔1次性或分次注射。对照组仅给予综合康复治疗。两组均于入院当天、治疗后7,15,30,60,90d进行运动与感觉、日常生活能力、膀胱功能评定。结果:24例患者均进入结果分析。①治疗组11例患者均有不同程度的感觉、运动和自主神经功能改善,与对照组比较,差异不显著。②治疗组ASIA分级A级8例,有2例在第60天、1例在第90天评估中恢复为B级。C级1例,在第30天评估中恢复为D级,第90天评估中恢复为E级,能独立行走,生活完全自理。D级2例,其中1例在第90天评估中恢复为E级。对照组A级9例,1例在第90天评估中恢复为B级。B级1例,治疗后无变化。C级2例,1例在第90天评估中恢复为D级。③骨髓间充质干细胞移植常见的不良反应包括低热(7/11例)、头痛(2/11例)、腹胀(1/11例),其中1例于蛛网膜下腔注射后出现双下肢麻木和脑膜刺激征,均于两三天内自行消失。结论:骨髓间充质干细胞移植治疗脊髓损伤近期有一定疗效而且安全,但远期疗效有待于进一步观察。

AIM： To observe the short-term curative effect and safe of autologous mesenchymal stem cells （MSCs） transplantation on patients with spinal cord injury （SCI）. METHODS： Totally 24 patients with SCI in the Shandong Disabled Rehabilitation Center were enrolled from April 2005 to February 2006. They were randomly divided into treatment group and control group, The patients knew the experiment and signed the informed consent. A total of 11 cases in the treatment group and 13 cases in the control group were diagnosed with CT or MRI and operated. It was comparable between the two groups in age, course of disease, degree of injury （ASIA rating） （P 〉 0.05）. On the basis of comprehensive rehabilitation treatment, those in the treatment group received autologous MSCs treatment, The bone marrow （156-180 mL） was harvested from the patients＇ ilia and then MSCs were isolated. The MSCs were injected intravenously or into subarachnoid space by lumbar puncture once or several times. Those in the control group only received comprehensive rehabilitation treatment. Motor function and sense, activity of daily living and bladder function were evaluated on the first day of hospitalization, 7, 15, 30, 60 and 90 days after treatment in the two groups. RESULTS： Totally 24 patients were involved in the result analysis. （1）The sense, motor and autonomic nerve function were improved to some extent in 11 patients of treatment group, Compared with the control group, there was no significant difference, （2）In the treatment group, there were 8 cases in the A grade of ASIA rating, 2 cases on the 60^t day and 1 case on the 90^th day recovered to B grade; 1 case in the C grade, and recovered to D grade on the 30^th day, E grade on the 90^th day independent walking was done with completely self-help living. Of the 2 cases in the D grade, 1 case recovered to E grade on the 90^th day. In the control group, there were 9 cases in the A grade, and 1 of them recovered to B grade on the 90^th day; 1 case in the B grade had no change after treatment; Of the 2 cases in the C grade, 1 case recovered to D grade on the 90^th day. （3）The side effect dunng MSCs transplantation included fever （7/11 cases）, headache （2/11 cases） and abdominal dissension （1/11 cases）, Of them, 1 case appeared anesthesia in his legs and meningeal stimulation after subarachnoid injection, and disappeared within two or three days. CONCLUSION： MSCs transplantation in treatment of SCI is effective and safe in the short term, but long-term curative effect needs more observation.