自体骨髓干细胞移植治疗神经系统损伤和变性疾病42例报告

Autologous bone marrow-derived mononuclear cell transplant for treatment of nervous system damage and degenerative disease:A report of 42 cases

目的:观察42例神经系统损伤和变性疾病患者经自体骨髓干细胞移植后,其神经系统症状与体征的改善。方法:①选取2005-06/2006-09解放军第四六三医院神经外科收治的神经系统损伤和变性疾病患者42例,对本试验均签署知情同意书。其中各种原因所致脊髓损伤30例,脑血管意外引起的偏瘫4例,老年痴呆2例,小脑疾患引起的共济失调2例,运动神经元变性疾病4例。患者入院后常规检查身体各项指标以评估是否适合行干细胞移植术。②术前患者均于皮下注射粒细胞集落刺激因子进行骨髓干细胞动员,5～12μg/(kg.d),连续4～5d。动员结束后患者在局麻状态下,于髂后上棘采集自体骨髓血约200mL,去除红细胞,密度梯度离心,分离出单个核细胞,再将收获的单个核细胞制成1.5mL细胞悬液(约1×108个细胞)备用。③通过手术或立体定向的方法将干细胞直接移植在神经损伤或变性部位,然后再根据病情经腰穿或静脉途径进行细胞移植,每次给予干细胞量按(2～3)×102个/kg计算,1次/周,共4周。④自体骨髓干细胞移植治疗过程中,为促进干细胞的生长和分化,根据患者病情及个人身体状况给予物理疗法、作业疗法等相应的康复功能锻炼,同时配以针灸、高压氧及药物营养神经和改善微循环治疗。结果:42例神经系统损伤和变性疾病患者均进入结果分析。自体骨髓干细胞移植治疗后1～3个月,17例脊髓损伤患者肢体症状明显改善,尤其是脑损伤后遗症引起的脊髓损伤其肢体症状改善更为显著;2例脑出血和1例脑血栓引起偏瘫的患者其肢体症状改善效果均较好;遗传性共济失调的2例患者疗效均不明显;1例老年痴呆患者其老年痴呆症状得到明显改善,并能在搀扶下行走,与旁人进行正常的交流;运动神经元变性病中1例患者肌萎缩性侧索硬化症改善效果较好,肌张力正常,颤抖减轻及至消失,多发性硬化中2例患者症状减轻。结论:干细胞移植配合功能锻炼等辅助手段对神经系统损伤和变性疾病的治疗效果肯定,有一定的临床应用价值。

AIM： To observe the improvement of nervous system symptom and physical sign in 42 cases of nerve system damage and degenerative disease after the autologous bone marrow stem cell transplant. METHODS： （1）Totally 42 cases of nerve system damage and the degenerative disease, who were admitted in Department of Neurology, the 463 Hospital of Chinese PLA from June 2005 to September 2006, were adopted in this study, with their informed consents. These cases, who were proved to suit stem cell transplant by hospitalized routine inspection, included 30 of spinal cord injury, 4 of hemiperalysis caused by cerebrovascular accident, 2 of dementia, 4 of motor nerve degeneration, and 2 of ataxia caused by cerebellum disease. （2）Before the therapy, the patients were subcutaneously injected with granular cell colony stimulation factor that was the marrow stem cell mobilization, 5-12 μg/ （kg-d）, for continuous 4-5 days. Then the 200 mL autologous bone marrow blood were gathered from posterior superior illiac spine, followed by eliminating red blood cell, conducting density gradient centrifugation, and separating the mononuclear cell, which was prepared into 1.5 mL cell fluid （approximately 1 xl08 cells）.（3）Through the surgery or stereotactic method, the stem cells were directly transplanted into the neurotrosis or the degenerated spot, then according to the patients＇ condition, the cell transplant was carried on by the lumber puncture or the vein way, at a dose of （2-3）×10^2 cells/kg, once a week, altogether 4 weeks.（4）During the autologous bone marrow stem cell transplant, the rehabilitative training such as the physical therapy, occupation therapy according to individual body condition, simultaneously matched with the acupuncture, the high-pressure oxygen, the neurotrophic medicine and the improvement of microcycle, woud all promote the growth and the differentiation of stem cells. RESULTS： All the 42 cases of nerve system damage and the degenerative disease were involved in the result analysis. （1）After 1-3 months of the treatment, 17 cases＇ of spinal cord injury presented the distinct improvement of body symptom, especially for those caused by brain injury sequela; 3 hemiparalysis patients were also good in body symptom improvement; 2 ataxia patients showed unobvious effect; 1 dementia patient had the distinct improvement, could walk with support and communicate freely; As for 1 patients with motor neuronal degeneration, amyotrophic lateral sclerosis was ameliorated good, muscular tension recovered to normal level, and shivering was relieved or disappeared; 2 multiple sclerosis patients＇ symptoms were reduced. CONCLUSION： The stem cell transplant treatment, matching with function training, has the affirmed curative effects on the nervous system damage and the degenerative disease, as well as certain clinical value.