神经干细胞移植治疗脑卒中后遗症59例

Neural stem cell transplantation for treating stroke sequela in 59 cases

目的:探讨神经干细胞移植注射治疗脑卒中后遗症的方法、效果、安全性及可行性。方法:选择于2002-11/2004-11河南省安阳市人民医院神经内科收治的59例脑卒中后遗症患者。纳入标准:①年龄<85岁。②无意识障碍。③病程1年以上。④患者及家属同意,并经医院伦理委员会批准。⑤无心、肝、肾和其他脏器严重的功能伤害。⑥不伴有癫痫。其中男39例,女20例,年龄27～83岁,平均(56.2±12.8)岁,脑梗死41例,脑出血18例,合并高血压38例,冠心病12例,糖尿病13例,高脂血症15例,病程1～30年,平均(5.1±6.0)年。采用鞘内注射法将培养的人胚胎神经干细胞移植到脑卒中后遗症患者脑内,并随访观察24个月,采用欧洲卒中量表评分标准、生活功能评分标准进行评分评价其疗效。欧洲卒中量表评分标准提高1分以上为有效,无提高或下降为无效。对所有患者行头颅电子计算机体层扫描、头部磁共振成像、心电图、肺部X射线片及血液生化学检查,评价此方法临床应用的安全性。结果:59例患者均进入结果分析。59例行鞘内注射患者中8例无效,51例有效。移植6个月后59例患者欧洲卒中量表评分标准及生活功能评分标准评分均较移植前明显提高[欧洲卒中量表评分标准:(54.5±222.3),(51.8±22.1)分,P<0.05;生活功能评分标准:(42.1±32.4),(36.3±32.7)分,P<0.05]。12例患者术后24h内出现一过性发热,体温37.4～38.5℃,给予对症处理后体温渐降。6例患者术后感轻微头痛。随访24个月时,检查患者头颅CT、磁共振成像、心电图、肺片及血液生化学指标较移植前均未发现明确变化。结论:鞘内注射移植神经干细胞治疗脑卒中后遗症有效可行。

AIM：To investigate the method, safety, efficacy and feasibility of neural stem cell transplantation for treating the sequeal of stroke. METHODS： Fifty-nine patients with the sequeal of stroke who received the treatment in the People＇s Hospital of Anyang from November 2002 to November 2004 were selected according to the standards （1）aged less than 85 years; （2）with no conscious disturbance; （3）with history of more than one year; （4）with the informed consent from the patients and their families, and approval from the Hospital Ethics Research Committee; （5）with no severe function lesion in heart, liver, kidney and other organs; （6）not combined with epilepsy. Among them, there were 39 males and 20 females, aged from 27 to 83 years, average of （56.2±12.8） years old; there were 41 cases with cerebral infarction, 18 with brain hemorrhage, 38 were combined with hypertension, 12 with coronary heart disease, 12 with diabetes, and 15 with hypedipodemia, the course of disease was ranged from 1 to 30 years, average of （5.1±6.0） years. Neural stem cells cultured from human embryonic brains were transplanted into all patients through lumbar acupuncture into subarachnoid space. After 24 months follow-up, the European Stroke Scale （ESS） and Barthel Index （BI） were adopted to evaluate the effect of transplantation. It was regarded as effective if the scores of ESS elevated one-or above; as ineffective if the scores were not improved even decreased. Meanwhile, CT, MRI, electrocardiogram （ECG）, lung-X-ray, and blood biochemical variables of all patients were also measured to evaluate the side effects of the transplantation. RESULTS： All 59 patients entered the result analysis. Among them, 8 were ineffective, and 51 were effective. Six months after transplantation, the scores of ESS and BI of all patients were significantly improved [ESS： （54.5±222.3）, （51.8±22.1） points, P〈 0.05; Bl： （42.1±32.4）, （36.3±32.7） points, P〈 0.05]. Of all the patients, 12 got a transitory fever of 37.4 to 38.5℃ within 24 hours after operation, and the body temperature was decreased after treatment; 6 felt slight post-operative headache. After 24 hours follow-up, no obvious alteration was found in the CT, MRI, ECG, lung-X-ray, and blood biochemical variables of all patients. CONCLUSION： Transplantation of neural stem cells by lumbar injection is an effective and feasible way to treat the sequeal of stroke.