两种干细胞移植方式对脑瘫患者运动功能改善的疗效比较

Therapeutic efficacy comparison of two modes of stem cell transplantation for improving motor function in 80 patients with cerebral palsy

【目的】对比两种干细胞移植方式改善痉挛型脑瘫患者运动功能的疗效。【方法】选取学龄前期组（3~6岁）及学龄期组（6~12岁）痉挛型脑瘫患儿各40例,将每组患者分为两亚组,每亚组20例患者分别接受腰椎穿刺蛛网膜下腔注射或脑立体定向手术的干细胞移植治疗,术后第6个月随访。评价粗大运动功能。【结果】（1）干细胞移植术后第6个月随访,80例患者术后粗大运动A、B、C、D、E功能区评分及总分均较术前明显提高,且其差异具有统计学意义（P〈0.05）。（2）学龄前期组中,头部立体定向手术组较腰椎穿刺手术组粗大运功功能评分无统计学差异（P〉0.05）。（3）学龄期组头部立体定向手术组粗大运动功能评分B区、D区、E区及总分改善明显优于腰椎穿刺蛛网膜下腔手术组（P〈0.05）,而A区、C区两种手术方式的差异无统计学意义（P〉0.05）。【结论】脐带间充质干细胞治疗痉挛型脑瘫疗效是肯定的;在学龄前期组的脑瘫患者建议选择损伤小的腰椎穿刺蛛网膜下腔注射干细胞移植方式;对学龄期组的痉挛型脑瘫患者,头部立体定向手术对于改善患者粗大运动功能疗效优于腰椎穿刺手术。

[Objective] To compare the efficacy of two kinds of stem cell transplantation for improving motor function in patients with spastic cerebral palsy. [ Methods ] A total of 80 patients with spastic cerebral palsy were divided into two groups： preschool-age group （3-6 years old） and school-age group （6-12 years old）, 40 cases per group. Then the patients in each group were averagely divided into two subgroups. The patients in one subgroup were treated with stem ceil transplantation via lumbar-puncture subarachnoid injection, while the cases in the other subgroup were treated with stem cell transplantation via brain stereotactic surgery. After the operation, the patients were followed up for 6 months. The gross motor function was evaluated. [ Results ] （1） When the 80 patients were followed up on the 6 month after the transplantation, the postoperative scores of gross rooter function in A, B, C, D and E areas as well as the total score were significantly higher than those before the operation （P〈0,05）; （2） In the preschool-age group, there was no significant difference in the postoperative score of gross motet function between brain stereotactic surgery subgroup and lumbar-puncture subarachnoid injection subgroup. （P〉0.05）; （3） In the school-age group, the total score and scores of B, D and E areas of gross motor function in the brain stereotactic surgery subgroup were significantly better than those in the lumbar-puncture subarachnoid injection subgroup （P 〈 0.05）, while there was no significant difference in the scores of A and C areas between the two subgroups （P 〉0.05）. [Conclusion] The therapeutic efficacy of umbilical cord mesenchymal stem cell transplantation for spastic cerebral palsy is affirmative. Preschoolage children with cerebral palsy are suggested to choose stem cell transplantation via lumbar-puncture subarachnoid injection, while school-age patients with spastic cerebral palsy are suggested for stem cell transplantation via brain stereotactic surgery which is better in improving gross motor fnnction.