自体骨髓基质细胞蛛网膜下腔移植治疗帕金森叠加综合征

Subarachnoid transplantation of autologous bone marrow stromal cells in treatment of Parkinson's plus syndrome

背景:研究证实脑室内、纹状体内移植骨髓基质细胞,能够改善帕金森病模型大鼠的症状,并增加脑内多巴胺的水平,目前仅有骨髓基质细胞治疗帕金森叠加综合征的个例报道。目的:探讨自体骨髓基质细胞经蛛网膜下腔移植对帕金森叠加综合征的治疗效果。设计:回顾性病例分析。对象:2006-2007年河北医科大学第一医院神经内科住院的7例帕金森叠加综合征患者,由神经内科主任医师根据患者的临床症状及辅助检查作出明确诊断。方法:移植前1d皮下注射重组人粒细胞集落刺激因子进行动员。取患者自体骨髓,体外分离培养制成骨髓基质细胞悬液(细胞总数1×107),注入蛛网膜下腔,移植后所有患者均使用常规抗帕金森病治疗手段。分别于移植前及移植后2个月,采用统一帕金森病评定量表(partⅠ、Ⅱ、Ⅲ、Ⅳ分别评价心理活动、日常生活活动、运动神经特性、并发症的治疗)、国际共济失调量表(包括姿势步态、肢体共济失调、构音障碍、眼球运动障碍4项因子)、日常生活能力量表、简易智力量表对患者临床症状的变化进行评定。主要观察指标:移植后临床疗效及各量表评分的变化。结果:7例患者均完成12个月随访,其中自觉症状明显好转4例,移植后轻度好转或病情未进展2例,基本无效1例。与移植前比较,移植后2个月患者统一帕金森病评定量表总分、partⅡ及partⅢ分数均明显降低(P<0.05),而partⅠ分数无明显变化(P>0.05);国际共济失调量表总分及姿势步态、肢体共济失调、构音障碍3项因子分数均明显下降(P<0.05),而眼球运动障碍因子分数无明显变化(P>0.05);日常生活能力量表分数明显增高(P<0.05);简易智力量表分数无明显变化(P>0.05)。结论:自体骨髓基质细胞蛛网膜下腔移植治疗能够改善帕金森叠加综合征患者的临床症状,在共济运动、言语及吞咽功能方面尤为突出,从而改善日常生活能力。

BACKGROUND： Bone marrow stromal cell transplantation in the ventricle and corpus striatum improves the symptoms of Parkinson＇s disease rat models and increases dopamine levels in the brain. There are case reports of bone marrow stromal ceils （BMSCs） for treating Parkinson＇s plus syndrome. OBJECTIVE： To study the effects of subarachnoid transplantation of autologous BMSCs on Parkinson＇s plus syndrome. DESIGN： Retrospective case analysis. PARTICIPANTS： Seven cases of Parkinson＇s plus syndrome were selected for this study at the Department of Neurology, First Hospital, Hebei Medical University between 2006 and 2007. They were diagnosed according to clinical symptoms and auxiliary examination by a chief physician at the Department of Neurology. METHODS： Recombinant human granulocyte colony stimulating factors were subcutaneously mobilized at 1 day before transplantation. Autologous bone marrow was obtained, made into BMSC suspension in vitro （total cell count 1×10^7）, and injected into the subarachnoid cavity. After transplantation, patients were subjected to conventional anti-Parkinson＇s method. Patients＇ symptoms were assessed in accordance with Unified Parkinson＇s Disease Rating Scale （UPDRS） （parts Ⅰ, Ⅱ, Ⅲ, Ⅳ were respectively used to evaluate mental activity, activities of daily living, motor nerve characteristics, complication therapy）, International Cooperative Ataxia Rating Scale （ICARS） （including gait, cooperative ataxia, dysarthrosis, ocular dyscinesia）, Activities of Daily Living Scale （ADL） and mini-mental state examination （MMSE）. MAIN OUTCOME MEASURES： Clinical outcomes and score changes following transplantation. RESULTS： 12-month follow-up was performed in 7 patients. Four patients was significantly improved with the subjective symptom, and two patients had slightly improved or had no improvement, and one patient was insufficient. Compared with that before transplantation, UPDRS, UPDRS H, UPDRS HI, ICARS scores of gait, cooperative ataxia, dysarthrosis were significantly decreased （P 〈 0.05） and ADL scores were significantly increased （P 〈 0.05） two months after transplantation, while UPDRS Ⅰ, ICARS scores of ocular dyscinesia, and MMSE scores had no statistical significance （P 〉 0.05）. CONCLUSION： Clinical symptoms of Parkinson＇s plus syndrome patients are improved by subarachnoid transplantation of autologous BMSCs, especially coordinative movement, language and swallowing function, resulting in activities of daily living are improved.