自体骨髓单个核细胞治疗脊髓损伤的临床研究

Clinical study of autologous marrow mononuclear cells transplantation in patients with spinal cord injury

目的:观察自体骨髓单个核细胞移植治疗脊髓损伤患者的近期疗效及其安全性。方法:34例脊髓损伤患者,采用随机表法分为治疗组和对照组。治疗组16例,对照组18例,均经CT或MRI确诊并行手术或非手术治疗。两组在年龄、病程、损伤程度(ASIA分级)等方面均具有可比性(P>0.05)。患者知情同意并签署知情同意书。治疗组在综合康复治疗的基础上给予自体骨髓单个核细胞(mononuclear cells,MNCs)治疗,经髂骨穿刺采集自体骨髓,分离提取骨髓单个核细胞后经静脉途径和/或蛛网膜下腔1次性或分次注射。对照组仅给予综合康复治疗。两组均于入院当天、治疗后第7、15、30、60、90天进行运动与感觉功能、日常生活活动能力、膀胱功能评定。结果:①治疗组感觉、运动和膀胱功能均有改善,但与对照组比较差异无显著性意义;②ASIA分级评定:治疗组共有5例患者在第90天评估中分别提高1-2级,对照组4例患者在第90天评估中分别提高1级;③MNCs移植的不良反应包括蛛网膜下腔移植后出现低热9例,头痛4例,腹胀1例;1例患者在注射后出现双下肢麻木、脑膜刺激征。经对症处理均于72h内消失。结论:自体骨髓MNCs移植治疗脊髓损伤近期有一定疗效而且安全,但远期疗效有待于进一步观察。

Objective：To observe the short-term curative effect and safety of autologous bone marrow mononuclear cells（MNCs） transplantation on patients with spinal cord injury（SCI）. Method： A total of 34 inpatients with SCI were randomly divided into treatment group and control group. The patients knew the experiment and signed the consent. A total of 16 cases in the treatment group and 18 cases in the control group were diagnosed with CT or MRI. It was comparable between the two group in age, course of disease, degree of injury （ASIA rating） （P〉0.05）. On the basis of comprehensive rehabilitation treatment, those in the treatment group received autologous MNCs treatment. The bone marrow（160--280ml） was harvested from the patients＇ ilia and then MNCs were isolated. The MNCs were injected intravenously or into subarachnoid space through lumbar puncture once or several times. Those in the control group only received comprehensive rehabilitation treatment. Motor function and sense, activity of daily living and bladder function were evaluated on the first day of rehabilitation, 7,15,30,60 and 90 days after treatment in the two groups. Result： All 34 patients were involved in the result analysis. ①The sense, motor and autonomic nerve function were improved to some extent in 16 patients of treatment group. Compared with the control group, there was no significant difference. ②In the treatment group, there were 5 cases elevated 1--2 grades respectively on the 90th day, In the control group, there were 4 cases elevated 1 grade respectively on the 90th day.③The side effects during MNCs transplantation included fever （9 cases）, headache （4 cases）, and abdominal distension （1 cases）. Of them, 1 case appeared numbness in his legs and meningeal stimulation after subarachnoid space injection, and disappeared within two or three days. Conclusion： MNCs transplantation in treatment of SCI is effective and safe in the short term, but long-term curative effect needs more observation.