间接血运重建联合自体骨髓干细胞动员及辛伐他汀治疗烟雾病

Indirect Revascularization Combined with Bone Marrow Stem Cell Mobilization and Simvastatin for the Treatment of Moyamoya Disease

目的探讨间接血运重建联合自体骨髓干细胞动员及辛伐他汀治疗烟雾病的临床疗效。方法选取59例烟雾病患者,根据患者治疗选择分为:A组,间接血运重建治疗对照组27例;B组,间接血运重建联合自体骨髓干细胞动员及辛伐他汀治疗组32例。测定各组外周血CD133+CD34+细胞数,并行日常生活能力评定(Barthel index)、中国卒中量表(CSS)评定、神经功能缺损评分(NIHSS评分)等对比分析。结果治疗后各时间点两组患者神经功能均有提高,B组分别显著高于A组(P<0.05)。B组外周血CD133+CD34+细胞数显著高于A组(P<0.05)。整个研究过程中,所有患者均未出现明显不良反应。结论间接血运重建联合自体骨髓干细胞动员及辛伐他汀治疗烟雾病,可促进神经功能的恢复,提高患者生活能力和质量,是烟雾病治疗的安全有效方法,值得临床推广。

Objective To assess the safety and efficacy of combination therapy of autologous bone marrow stem cells （BMSCs） and simvastatin for moyamoya disease. Methods 59 patients with moyamoya disease were enrolled and analyzed retrospectively. They were assigned into 2 groups according to the treatment：A group （indirect revascularization treatment as control） , B group （BMSCs mobilization ＋ simvastatin ＋ indirect revascularization treatment）. The patients underwent preoperative and follow - up neurological assessment using the Barthel Index （BI） , the Chinese stroke volume table （CSS） and neurological impairment （NIHSS score）. Peripheral blood CD133 ＋ CD34 ＋ cells were analyzed with flow cytometer. Results All of the 59 patients were smoothly discharged. Compared with group A, sig- nificant functional improvement was seen （the CSS, Barthel index and NIHSS score） in group B. The CD133 ~ CD34 ＋ cells in group B were significantly higher compared with group A. No patients experienced serious complications during the treatment. Conclusion Indi- rect revascularization combined with bone marrow stem cell mobilization and simvastatin could enhance functional recovery in moyamoya patients which is an effective and safe strategy, and is worthy to apply in clinic.