骨髓和脐血间充质干细胞改善肌营养不良患者肌力的临床观察

Functional improvement of patients with progressive muscular dystrophy by bone marrow and umbilical cord blood mesenchymal stem cell transplantations

目的观察骨髓和脐血间充质干细胞双移植方案治疗进行性肌营养不良（PMD）患者的安全性和有效性。方法2007年6月至2008年6月对经血清酶学、肌电图、基因分析、肌肉活检、肌肉磁共振成像（MRI）确诊的82例PMD患者采用干细胞双移植方案进行治疗。采用自身治疗前后对照方法进行研究，随访Z～12个月。治疗方法：①骨髓间充质干细胞（BMSC）：经双侧髂后上脊穿刺采集骨髓80～150ml，Ficoll密度梯度离心分离单个核细胞并诱导分化为BMSC。②人脐血间充质干细胞（CB—MSC）：采集脐带血80～160ml，CB—MSC制备过程同BMSC。③干细胞移植术：收集BMSC和CB—MSC，制备成1×10^8／m]BMSC细胞悬液和1×10^7／mlCB—MSC细胞悬液，分次移植于患者的四肢肌肉内和静脉内。移植后3、6、9、12个月观察患者日常生活活动能力评价（ADL）、临床分级疗效评定、酶学、肌电图、肌肉MRI变化。结果82例患者干细胞移植后3、6、9、12个月进行临床分级疗效评定，显效31例（37．8％），有效37例（45．1％），无效14例（17．1％），总有效率为82．9％。70例患者（85．4％）肌力提高，肢端温暖、食欲改善、动作灵活、体重增加。72例患者ADL评分增加（87．8％），治疗前后结果差异有统计学意义（P〈0．01）。于细胞移植后LDH降低，差异有统计学意义[（475±223）u／L比（410±216）u／L，P〈0．05，t=6．650]，肌酸激酶f（2952±2259）u／L比（2841±2092）u／L，P=0．225，t=1．094]、肌酐[（26±12）μmol／L比（25±11）μmol／L，P=0．306，t=1．029]轻度降低，但差异无统计学意义。干细胞双移植方案实施中儿童患者依从性好，未发生不良反应及并发症。结论干细胞双移植方案治疗进行性肌营养不良可使82．9％的患者获得临床症状改善，运动功能及肌力提高，安全性好，无排斥反应，是一种治疗进行性肌营养不良的新手段。

Objective To investigate the feasibility of employing double transplantations of autologous bone marrow mesenchymal stem cells （BMSC） and umbilical cord mesenchymal stem cells （UMSC） in the treatment of progressive muscular dystrophy （PMD）. Methods A total of 82 cases were treated by the double transplantations of BMSC and CB-MSC. They were diagnosed by clinical manifestations, CK, LDH, genetic analysis, electromyography, MRI and pathologic examination of biopsied muscle specimens from July 2007 to July 2008. Control group was self-made at before and after treatment and cases were followed up for 3-12 months, treatment method： Eighty-two patients underwent the double transplantations of bone mesenchymal stem cell（BMSC） and human umbilical cord blood MSC（CB-MSC）. （1） BMSC ：80-150ml bone marrow sample was collected through a puncture at bilateral posterior superior iliac spine. Ficoll density gradient centrifuge was employed to separate individual monocyte for induced differentiation. （2） CB-MSC： 80-160ml umbilical cord blood was harvested and processed likewise as above. （3） Stem cell transplantation： Both BMSC and CB-MSC were collected and prepared into 1 ×10^8/ml and 1 ×10^7/ml cell suspension respectively. They were transplanted in divided does into the extremity muscle and vein. The clinical and laboratory parameters were monitored at 3, 6, 9 and 12 months. Results It was found that 31 cases（37. 8% ）obtained a remarkable efficacy, 37 cases（45. 1% ）were effective and 14 cases （17. 1% ）had no change. Total effective rate was 82.9%. Seventy patients（85.4% ）felt limbs warmly, appetite improved, gained weight, had better appetite and action were nimble. Activity of daily living scale （ADL） in 72 patients （87. 8% ）increased as compared with pre-treatment （P 〈 0. 01 ）. LDH decreased at post-treatment[ （475 ± 223 ） u/L vs （410 ± 216） u/L, P 〈 0. 05, t = 6. 650 ]. Creatine kinase [ （ 2952 ± 2259） u/L vs （2841 ± 2092） u/L, P = O. 223, t = 1. 094 ] and creatine [ （ 26 ± 12 ） μmol/L vs （ 25 ±11 ） μmo//L,P = 0. 306, t = 1. 029 ] decreased slightly. Adherence to therapy among Children and no adverse reaction was reported during the course of treatment. Conclusion The double transplantation of BMSC and CB-MSC is convenient, safe and effective in the treatment of progressive muscular dystrophy and can be considered as a new therapy of PMD. MSC represents a possible tool of cellular therapeutics for PMD.