人胚胎嗅鞘细胞脑内移植治疗脑卒中后疼痛1例

Fetal olfactory ensheathing cell transplantation for post-stroke pain in one case

目的：探讨人胚胎嗅鞘细胞脑内移植对脑卒中后中枢性疼痛的有效性。方法：取4个月中期流产胚胎的嗅球，孕妇及其家属对实验知情同意，并经医院伦理委员会批准，消化成单个嗅鞘细胞后，培养2周。供、受体细胞HLA配型后行人胚胎嗅鞘细胞脑内移植。1例72岁男性患者因“右侧肢体感觉、运动障碍伴疼痛8年”入院。入院后诊断：①脑出血后遗症。②原发性高血压。于入院后第4天在局麻下采用人胚胎嗅鞘细胞脑内移植，细胞植入到脑出血侧放射冠处，注射细胞数约1×10^10L^-1。移植前后2～4周分别采用临床神经功能评定量表、Barthel Index评定量表评价患者神经功能。临床神经功能缺损评定标准：轻型：0～15分，中型：16～30分，重型：31—45分；Barthel Index评定量表评定标准：60分以上提示被检查者生活基本可以自理，41-60分者生活需要帮助，20—40分者生活需要很大帮助，20分以下者生活完全需要帮助，Barthel指数40分以上者康复治疗的效益最大。结果：嗅鞘细胞移植后患者无发热、血小板变化等血液相容性不良反应及其他并发症。术后第1天，患者自诉右侧肢体疼痛较以前减轻70％，肌张力较以前有所减轻，右手活动较以前灵活。腰部肌力较以前增加。术后第2天，右侧肢体疼痛较以前减轻80％，右手及脚趾活动较以前灵活。术后第5天，右侧肢体疼痛较以前减轻90％，肌张力继续降低。术后3周患者病情平稳出院。临床神经功能缺损评分总分由12分增至14分；Barthel Index评分前后无变化为85分。结论：人胚胎嗅鞘细胞脑内移植对卒中后疼痛近期效果理想，长期效果有待随访。

AIM： To probe the effectiveness of fetal olfactory ensheathing cell （OECs） transplantation in the treatment of central pain after stroke. METHODS： The olfactory bulb taken from the 4-month second trimester abortion fetal （the pregnant woman and their family signed the informed consents） was digest into single OECs and cultured for 2 weeks. The experiment was approved by Hospital Ethical Committee. After the donor and recipient cell HLA zygosity, the fetal OECs were transplanted into the brain. Case report： A 72-year-old patient presenting with right limb sensation and motor disturbance with pain for 8 years was referred to our institute. On admission he got the diagnosis of cerebral hemorrhage sequelae and primary hypertension. Fourth day after his admission, under local anesthesia the fetal OECs was transplanted into the corona radiata of cerebral hemorrhage side with 1 × 10^10 L^-1. The Clinical Neurologic Impairment and Barthel Index were deployed to evaluate the neurological function of the patient 2-4 weeks before and after transplantation. Clinical Neurologic Impairment Evaluation Standard： mild presented as 0-15 scores, medium as 16-30 scores, severe as 31-45 scores; Barthel Index Evaluation Standard： the patient whose score is above 60 points hints that his life almost can be self-care, from 41-60 points suggests that his life needs help, from 20-40 points shows that his life needs great help, below 20 points demonstrates that his life completely needs help. The patient whose score of the Barthel Index that above 40 points can have the biggest efficiency of rehabilitative treatment. RESULTS： There was no untoward reaction of blood compatibility such as fever and changes in the platelet and other complications after transplantation. First day after surgery, the patient felt that the pain on his right limbs decreased by 70% than before, the muscular tension decreased a little bit, he was able to move his right finger more freely, and the muscular power of his waist increased. Second day after surgery, the pain on his right limbs decreased by 80%, he was able to move his fingers and toes more freely; Fifth day after surgery, the pain on his right limbs decreased by 90%, and the muscular tension was still decreasing. Three weeks after surgery, the patient＇s condition was stable and he discharged. The score of Clinical Neurologic Impairment increased from 12 points to 14 points. No change in Barthel Index was found and the score was 85 points. CONCLUSION： The short-term outcome of fetal olfactory ensheathing cell transplantation for pain after stroke is good, while the long-term outcome is required to be followed up.