自体骨髓间充质干细胞移植治疗脑出血32例:是否安全、可行及有效?

Whether autologous bone marrow mesenchymal stem cell transplantation is safe,feasible,and effective to the treatment of intracerebral hemorrhage:A 32-case analysis

背景:大量动物实验证实骨髓间充质干细胞在适宜条件下能够定向分化为神经细胞,但目前其应用于临床治疗神经系统损伤性疾病的报道较少。目的:观察自体骨髓间充质干细胞移植治疗脑出血的近期疗效。方法:以2007-11/2009-01聊城市脑科医院神经外科收治的32例脑出血患者作为治疗组,根据患者一般状况及血肿量大小,分别行钻孔引流或开颅血肿清除,均留置血肿腔引流管,退至血肿腔边缘,通过引流管注射自体骨髓间充质干细胞悬液3.5mL。选择同期入院但未行干细胞移植的40例患者作为对照组。分别于移植前和移植后6个月进行神经功能缺损程度评定(NIHSS评分)和日常生活活动能力评定(Barthel指数),行颅脑MRI、血生化指标、肿瘤标记物检查,监测干细胞移植的安全性。结果与结论:移植前两组患者NIHSS评分及Barthel指数基本相似。与对照组比较,移植后6个月治疗组NIHSS评分显著降低(P<0.01),Barthel指数显著升高(P<0.01)。与移植前比较,治疗组在移植后6个月NIHSS评分显著降低(P<0.01),Barthel指数显著升高(P<0.01)。治疗组2例患者在移植后出现一过性发热,予对症处理后症状缓解。移植后6个月随访,除1例患者因肺癌导致肿瘤标记物CA-153升高外,颅脑MRI及血生化指标均未出现明显异常,说明自体骨髓间充质干细胞移植治疗脑出血是安全可行的,且在近期内疗效确定,远期疗效尚待进一步观察。

BACKGROUND：Previous animal studies demonstrated that bone marrow mesenchymal stem cells could differentiate into nerve cells under a certain condition;however,the clinical application for treating nervous system disease has been less reported.OBJECTIVE：To observe a short-term effect of autologous bone marrow mesenchymal stem cell transplantation on treating cerebral hemorrhage.METHODS：A total of 32 patients with cerebral hemorrhage who were selected from the Department of Neurosurgery,Liaocheng Brain Hospital between November 2007 and January 2009 were considered as a treatment group.According to general data and the amount of hematoma,they were treated by drilling drainage or hematoma evacuation.Drainage tubes were detained into hematoma cavity,and 3.5 mL autologous bone marrow mesenchymal stem cell suspension was injected through drainage tube.A total of 40 additional patients who did not treated with stem cell transplantation were considered as a control group.Neurologic impairment （NIHSS） and activities of daily living （Barthel index） were performed before and 6 months after transplantation;meanwhile,the brain MRI,serum biochemical and tumor marker were evaluated to detect security of stem cell transplantation.RESULTS AND CONCLUSION：The NIHSS score and Barthel index in the treatment group were similar to those in the control group before transplantation.Compared with control group,NIHSS scores were significantly decreased in the treatment group （P 0.01）,but Barthel index was significantly increased 6 months after transplantation （P 0.01）.Compared with before transplantation,NIHSS score were significantly decreased （P 0.01）,but Barthel index was significantly increased in the treatment group 6 months after transplantation （P 0.01）.Two patients in the treatment group had febrile,which was recovered after treatment.The following-up 6 months after transplantation demonstrated that brain MRI and biochemical indicators were normal except an increasing of CA-153 caused by lung cancer in one patient.The autologous bone marrow mesenchymal stem cell transplantation for treatment of cerebral hemorrhage is safe and effective in a short-term period;however the long-term effect still needs to be further studied.