脐带间充质干细胞治疗脊髓损伤临床分析

Clinical analysis of umbilical cord mesenchymal stem cells in treatment of spinal cord injury

目的观察脐带间充质干细胞(UC-MSCs)鞘内注射治疗脊髓损伤(SCI)的临床效果及安全性。方法对2008年1月至2010年10月收治的22例SCI患者,给予UC-MSCs鞘内注射治疗,细胞数1×106个/(kg.次),1次/周,4次为1个疗程,其中4例接受2个疗程,1例接受3个疗程,余均接受1个疗程。采用美国脊髓损伤协会制定的脊髓损伤神经功能评分标准(ASIA标准)对患者治疗前后神经功能进行评定,采用国际神经修复学会脊髓损伤功能评价量表(IANR-SCIRFS)对患者治疗前后日常生活活动能力进行评定。结果 22例患者中13例有效,9例无效。不完全性SCI患者有效率达81.25%,完全性SCI的6例患者均无效。有5例有效的患者接受了2～3个疗程治疗,疗效均有进一步的提高。有效患者多表现为运动和/或感觉功能改善,大小便控制能力增强。22例患者治疗后1个月与治疗前比较,痛觉、触觉、运动、日常生活活动能力评分均有明显升高(P<0.01)。治疗后常见的不良反应有头痛(1例)、腰痛(1例),均在1～3d内消失。随访3个月至3年,无治疗相关不良事件发生。结论 UC-MSCs鞘内注射治疗是安全的,可以改善大部分不完全性SCI患者的神经功能,提高这些患者的生活质量。

Objective To observe the clinical effect and safety of umbilical cord mesenchymal stem cells （UC-MSCs） in treating spinal cord injury （SCI） by intrathecal injection. Methods From January 2008 to October 2010, 22 admitted patients with SCI were given UC-MSCs by intrathecal injection, at a dose of 1 × 10^6 cells/kg body weight once a week, 4 times as a course. Besides 4 cases received 2 courses and 1 case received 3 courses, others received 1 course. American Spinal Injury Association （ASIA） scoring sys- tem and International Association of Neurorestoratology SCI Functional Rating Scale （IANR-SCIFRS） were used to evaluate SCI patients＇ neural function and ability of daily living. Results Among 22 cases, 13 cases were effective, 9 cases had no response. The effective rate of incomplete SCI cases was 81.25% , all of 6 cases with complete SCI had no response. There were five effective patients received 2-3 courses therapy, and effects were further enhanced. In most effective patients, motor and/or sensory functions improved,bowel and bladder control improved. One month after therapy compared with before therapy, 22 patients＇ algaesthesis, tactile sensation, motion, activity of daily living scale were obviously increased （ P 〈 0.01 ）. After therapy, common adverse effects were headache （ 1 case）, low back pain （ 1 cases） , all disappeared within 1-3 days. Following up 3 months to 3 years, no treatment-related adverse events occured. Conclusion UC-MSCs therapy by intrathecal injection is safe, and can ameliorate most of incomplete SCI patients＇ neu- rological function,as well as improve these patients＇ quality of life.