脐血间充质干细胞移植治疗小儿痉挛性脑瘫的临床研究

Clinical study of umbilical cord blood mesenchymal stem cell transplantation in the treatment of spastic cerebral palsy in children

目的 观察脐血间充质干细胞(UCMSCs)移植治疗痉挛性脑性瘫痪的临床疗效。方法 采用随机数字表法将痉挛性脑性瘫痪患儿20例分为对照组(12例,Vojta运动疗法)和治疗组(8例,UCMSCs移植疗法)。脐血采集前经产妇知情同意并签订知情同意书,各项检测指标均为阴性。分离后的细胞经过培养、传代,流式细胞仪鉴定细胞免疫表型,治疗组患儿经静脉途径分次注射UCMSCs,7 d注射1次,4次为1疗程。分别对2组治疗前、后对患者肌张力、运动功能进行评价,对2种治疗结果进行对比。结果 组内比较,治疗组经UCMSCs移植疗法14 d后MAS评分较治疗前显著下降(2.07±0.45 vs 2.96±0.79),对照组经Vojta运动疗法治疗60 d后MAS评分较治疗前显著下降(1.95±0.43 vs 2.92±0.64);组间比较,治疗14 d后对照组MAS评分显著低于对照组(2.07±0.45 vs 2.83±0.68)(P<0.05)。治疗3个月后,2组患者脑性瘫痪综合功能评分(18.87±8.22vs 32.42±5.36,26.25±6.39 vs 33.62±5.96)和GMFM评分(37.45±8.14 vs 55.79±10.13,45.33±8.34vs 56.05±9.17)与治疗前组内比较P<0.05;组间比较,治疗组脑性瘫痪综合功能评分和GMFM评分(18.87±8.22 vs 26.25±6.39,37.45±8.14 vs 45.33±8.34)显著低于对照组(P<0.05)。治疗组1例患者UCMSCs移植后为出现发热(体温为38.6℃);Vojta运动疗法不良反应暂未发现。结论 UCMSCs移植治疗痉挛性脑瘫与Vojta比较,疗效快,可显著降低患儿肌张力,提高运动能力。

To observe the clinical effect and adverse reactions of umbilical cord blood mesenchymal stem cell(UCMSCs)transplantation for the treatment of spastic cerebral palsy.Methods Twenty children with spastic cerebral palsy were divided into control group(12 cases treated with Vojta motor therapy)and treatment group(8 cases treated with UCMSCs transplantation therapy)by random number table method.Before umbilical cord blood collection,informed consent was obtained and informed consent was signed.The separated cells were cultured and passaged,and the cell immunophenotype was identified by flow cytometry.The children in the treatment group were injected with UCMSCs by intravenous route,once every 7 days and four times per course of treatment.The muscle tone and motor function of the two groups were evaluated before and after treatment,and the two treatment results were compared.Results Compared with the control group,the MAS score of the treatment group after 14 days of UCMSCs transplantation significantly decreased(2.07±0.45 vs.2.96±0.79),while that of the control group after 60 days of Vojta exercise therapy significantly decreased(1.95±0.43 vs.2.92±0.64).After 14 days of treatment,the MAS score of the control group was significantly lower than that of the control group(2.07±0.45 vs.2.83±0.68,P<0.05).After 3 months of treatment,the scores of comprehensive function(18.87±8.22 vs.32.42±5.36;26.25±6.39 vs.33.62±5.96)and GMFM(37.45±8.14 vs.55.79±10.13;45.33±8.34 vs.56.05±9.17)in the two groups were statistically significant higher than before(P<0.05).The scores of comprehensive function and GMFM in the control group were significantly lower than those in the control group(18.87±8.22 vs.26.25±6.39;37.45±8.14 vs.45.33±8.34,P<0.05).One case of fever(temperature of 38.6℃)after transplantation in UCMSCs treatment group was observed;no adverse reactions to Vojta exercise therapy had been detected.Conclusion Compared with Vojta,UCMSCs transplantation is effective in treating spastic cerebral palsy.