嗅鞘细胞移植治疗额颞叶痴呆1例

Human fetal olfactory ensheathing cell transplantation for frontotemporal dementia in 1 case

目的:观察人胚胎嗅鞘细胞移植治疗额颞叶痴呆的有效性。方法:选择2006-04-04于北京市虹天济神经科学研究院和北京市西山医院暨北京康复中心神经外科就诊患者1例,男性,57岁,因“行为异常,性格及言语改变2年4个月”入院。患者知情同意并签署知情同意书。入院查体双侧Hoffmann征可疑阳性,双侧Babinski征未引出。头颅MRI示双侧额颞叶脑沟、侧裂池增宽,脑实质萎缩明显,诊断为额颞叶痴呆。局麻下对患者进行人胚胎嗅鞘细胞移植术,于双侧额叶放射冠位置分别注射人胚胎嗅鞘细胞约100万个。移植前后使用日常生活活动量表评价患者神经功能。量表包括吃饭、穿衣、购物等20个日常行为活动项目。评分分4级:1级-可由自己完成,无困难;2级-完成有些困难;3级,需要帮助;4级-能力丧失,根本无法完成;如受试者从未做过的项目或无从了解的项目,则记为9,不计入总分。总分20分为正常;>20分为功能低下。结果:术后无任何并发症及不良反应。移植术后3周患者情感、认知方面有所改善。日常生活活动量表与术前比较,分数由43分下降至32分。术后6周电子邮件随访,神经功能继续改善。结论:人胚胎嗅鞘细胞移植后近期可部分改善额颞叶痴呆患者神经系统功能,提高生活质量,其恢复机制和长期效果有待进一步观察。

AIM： To observe the effectiveness of human fetal olfactory ensheathing cell （OEC） transplantation in the treatment of frontotemporal dementia （FTD）. METHODS： One 57-year-old male inpatient from Beijing Hongtianji Neuroscience Academy and Department of Neurosurgery, Beijing Xishan Hospital ＆ Beijing Rehabilitation Center April 4^th, 2006 were enrolled in the trail with the patient＇s informed consent, and because of FTD for about 2 years and 4 months, he was treated in hospital. After body examination, Hoffmann symptom showed probable positive, but bilateral Babinski symptom was not seen. MRI in skull showed bilateral frontotemporal anfractuosity and lateral cleft cistern widened and parenchyma was atrophied obviously, diagnosing as having FTD. Under local anesthesia, the surgical transplantation of OEC procedure was performed. 1 000 000 OEC were injected into the bilateral frontal lobe of the patient＇s brain. Neurologic function was evaluated by Activity of Daily Living Scale （ADL） before and after the transplantation. The scale included 20 daily activities, such as having a meal, putting on clothes, shopping and so on. The score included 4 grades： 1 grade as living on one＇s own, no difficulty, 2 grade as some difficulty, 3 grade as needing help and 4 grade as lost of living ability, could not live on one＇s own. For the items that the subject did not do before or did not understand, it was 9 points, which did not record into the total score. Total score of 20 points as normal, and over 20 points as low function. RESULTS： No any complications and adverse effects were observed after the transplantation. Three weeks after the procedure, emotion and cognition ability ameliorated. The score of ADL scale was 32 points, which decreased by 11 points compared with that before operation. During the 6-week follow up by E-mail, neurologic function still kept improving. CONCLUSION： Human fetal OEC transplantation can ameliorate neurologic function of FTD patient and elevate quality of life in the near future. Further research about the long-term outcome of the treatment and the mechanism of recovery is required.