微囊化牛肾上腺髓质细胞蛛网膜下腔移植治疗晚期癌症疼痛10例

Microencapsulated bovine adrenal chromaffin cell transplantation for 10 patients with advanced cancer pain

背景:临床上慢性癌痛患者常应用阿片类药物镇痛,但仍然有很多不良反应。国内也曾有报道采用海藻酸钠-聚赖氨酸-海藻酸钠微囊化牛肾上腺嗜铬细胞移植治疗慢性癌痛。但聚赖氨酸作为人工合成的阳离子聚合物,价格昂贵,且海藻酸钠聚赖氨酸强度不足,一定程度上限制了其在临床上的应用。而壳聚糖是一类天然高分子多糖,来源广泛、价格低廉且具有良好生物相容性,成为聚赖氨酸良好的替代材料。目的:观察海藻酸钠-壳聚糖-海藻酸钠微囊化牛肾上腺嗜铬细胞异种移植对慢性癌痛患者的镇痛效应、作用持续时间及不良反应。设计、时间及地点:回顾性病例分析,病例来自于2007-01/2008-12大连大学附属中山医院肿瘤科。对象:中、晚期恶性肿瘤患者10例,年龄46～78岁,女1例,男9例。用视觉模拟疼痛评分法评价疼痛程度,中度疼痛3例,重度疼痛7例。方法:用胶原酶加机械法消化分离牛肾上腺嗜铬细胞,二步法包裹于海藻酸钠-壳聚糖-海藻酸钠微囊内。局麻下腰椎穿刺将5mL微囊化牛肾上腺嗜铬细胞悬液(5～7)×106缓慢注入中、晚期恶性肿瘤患者蛛网膜下腔。主要观察指标:移植后疼痛的缓解程度,止痛作用持续时间及不良反应。结果:将微囊化牛肾上腺嗜铬细胞注入患者脊髓蛛网膜下腔后疼痛便得到不同程度的缓解,1周内疼痛完全缓解2例,部分缓解1例,轻度缓解4例,3例未缓解。移植后可出现轻度马尾神经刺激症状,患者诉腰部酸胀,3～5d内症状消失。结论:海藻酸钠-壳聚糖-海藻酸钠微囊化牛肾上腺嗜铬细胞异种移植于慢性癌痛患者脊髓蛛网膜下腔安全,且能够迅速发挥镇痛作用。

BACKGROUND：Opiate drugs are widely used to control chronic cancer pain,which brings many adverse reactions.Transplantation of sodium alginate-polylysine-alginate microencapsulated bovine adrenal chromaffin cell （BCC） has reported to be used as chronic cancer pain controllers.However,the high price and poor strength of polylysine limited its clinical application.Chitosan is characterized by sufficient resource,low price and good biocompatibility,which is a substitute for polylysine.OBJECTIVE：To study the effect of xenotransplantation of sodium alginate-chitosan-alginate （ACA） microencapsulated BCC on patients with advanced cancer pain.DESIGN,TIME AND SETTING：A retrospective case analysis.All cases were obtained from Department of Oncology,Affiliated Zhongshan Hospital of Dalian University from January 2007 to December 2008.PARTICIPANTS：Totally 10 patients with advanced cancer,including 1 female and 9 males,aged 46-78 years.According to visual algetic mimic scale （VAS）,3 patients suffered moderate pain and 7 cases suffered severe pain.METHODS：Microencapsulation method was applied to encapsulate BCC with ACA membrane and transplant the microencapsulated BCC （5-7）×106 into the subarachnoids pace of 10 patients.MAIN OUTCOME MEASURES：The degree of pain release,duration of analgesic effect,as well as adverse reaction.RESULTS：All 10 patients had pain relief rapidly after transplantation in varying degrees.Complete pain relief was shown in 2 cases,medium relief in 1 case,slight relief in 4 cases.Slight irritation of cauda eguina was presented after transplantation,which could disappear within 3-5 days.CONCLUSION：Xenotransplantation of ACA microencapsulated BCC into the spinal subarachnoids pace of patients with cancer pain can produce analgesic effect promptly,significantly,and safely.