我国干细胞治疗神经系统疾病有关文献的初步分析

Preliminary analysis of literatures related to stem cells treatment of nervous system diseases in China

目的探讨干细胞治疗的神经系统疾病病种、年龄分布、干细胞种类、移植途径、治疗效果及随访情况，以为广大医务工作者提供一些参考，从而推动干细胞在临床应用方面走的更远。方法应用计算机在万方全文数据库以“干细胞、脑、治疗、临床、患者；题名：干细胞、例；关键词：干细胞、脑；摘要：干细胞、脑、治疗、临床”和“干细胞、神经、治疗、临床、患者；题名：干细胞、例；关键词：干细胞、神经；摘要：于细胞、神经、治疗、临床”为检索策略，限定文章语言种类为中文，起始时间未做限定，终点时间限定为2012年5月止，分别得到文献156篇、234篇，获得文献阅读后进一步剔除，最终得到69篇有价值的文章见参考文献。结果①2259例患者接受干细胞治疗，疾病种类涉及脊髓病变、脑血管病、运动神经元病、帕金森病等，其中脊髓病变最多（36％）；②年龄跨度为0．5岁-78岁，男女比为1477：782；③所用干细胞种类以自体骨髓间充质干细胞和脐带源最多见；④多以腰穿鞘内注射作为移植途径，治疗效果因观察指标不统一，无法具体计算显效率、好转率等指标，但所有报道均示有一定效果，且副作用少；⑤随访时间不等，最短1周，最长达37个月，多集中在3个月、6个月。结论在我国干细胞已被临床上用于治疗多种神经系统疾病，有一定效果，但没有统一的和／或优先的干细胞移植途径、移植条件及移植时间窗，且研究多为单中心、小样本、非随机的研究，以后需要更多的临床病例和随访资料，最好是采用多中心、随机、双盲、安慰剂平行对照的试验方法去获得最有价值的临床循证依据。

Objective To investigate the effects of the treatment of nervous system diseases with stem cells, which would be conducive to clinical application, involving the types of diseases, age distribution of the patients, the types of stem cells, the ways of transplantation and follow-up of the cases. Methods We searched the related publications from Wanfang Database, setting the deadline to 2012-05-31, with index words as： “stem cells, brain, therapy, clinical, patient AND title： stem cell, case AND keyword： stem cell, brain AND abstract： stem cells, brain, therapy, clinical, patient”, or with index words as：“stem cells, nerve, therapy, clinical, patient AND title： stem cell, case AND keyword： stem cell, nerve AND abstract： stem cells, nerve, therapy, clinical, patient”. 156 papers were found by the first search strategy, while 234 papers were found by the second search strategy. Only 69 of them were evaluated as valuable. Results ① The total number of cases was 2 259, with 1 477 male and 782 female ; the types of diseases involving spinal cord lesions, cerebral vascular diseases, motor neuron diseases and Parkinson＇s disease, etc. ② The age of all cases ranged from 0.5 to 78 years. ③ The majority of the stem cells were harvested from bone marrow and umbilical cords. ④ Being lack of uniform criteria, it is difficulty to calculate the definite efficiency, but some certain effects were reported in all papter, with less side effects. ⑤ The post-operative follow-up time ranged form 1 week to 37 months. Conclusions In China, stems cell therapies have already been applied in the clinic for the treatment of different nervous system diseases. But to date, all these studies were only single center nonrandomized studies with small samples. Thus, it is still difficultied to establish the uniform standard of the types of stem cells, the way of transplantion, etc. Therefore, more evidences on the basis of the evidence-based medicine are needed to make a clear conclusion in this field.