颈动脉与鞘内注射脐带血干细胞治疗一氧化碳中毒迟发性脑病的临床研究

Efficacy of carotid and intrathecal injection of umbilical cord blood stem cell in the treatment of delayed encephalopathy after carbon monoxide poisoning

目的观察脐带血干细胞蛛网膜下腔及颈动脉注射治疗一氧化碳中毒迟发性脑病（DEACMP）的安全性及治疗效果。方法收集沧州市中心医院2012年10月至2015年9月期间因DEACMP入院治疗的患者32例，设立治疗组：对17例DEACMP患者以颈动脉及鞘内进行间充质干细胞（MSC）注射，每次注射MSC为2×10^7，每次间隔7d，注射4次为1疗程并在治疗前和治疗后与对照组进行影像学和症状体征，治疗副作用及智能精神状态评分（MMSE）和日常生活活动能力（Barth1）评分；对照组：仅给予常规改善脑代谢药物胞二磷胆碱等及维生素类药物治疗。对2个组不能进食者予以补液治疗。各组数据使用重复测量资料的方差分析对结果进行统计分析。结果所有患者在干细胞治疗中均无特殊不适，均未出现治疗不良反应。治疗组患者MMSE评分为94.35±12．56，高于对照组3．24±2．32（t=27．6288，P=0．000）；治疗组Barth1评分为93．60±13．36，高于对照组6．39±6．80，差异均有统计学意义（t=22．3845，P=0．000）。治疗组影像检查结果好转率为76．47％，对照组好转率为26．66％两组比较差异有统计学意义（χ^2=4．402，P=0．0359）。结论MSC颈动脉与鞘内注射治疗DEACMP效果显著。

Objective To observe the safety and therapeutic effect of injection of umbilical cord blood stem cell in subarachnoid space and carotid artery in the treatment of delayed encephalopathy after carbon monoxide poisoning （DEACMP）. Methods From October 2012 to September 2015, patients with DEACMP （n = 32） admitted to our hospital were enrolled and were divided into the treatment group （n = 17） and the control group （n = 15）. Patients in the treatment group received carotid and intrathecal injection of MSCs （2× 10^7 cells weekly for 4 weeks）. Patients in the control group were given medicines for improving cerebral metabolism （Cytidine Diphosphate Choline, etc.） and vitamins. The imaging characteristics, signs and symptoms, side effects of treatment, MMSE scores and Barthl scores were compared between the treatment group and the control group before and after treatment. Patients who could not take food received parenteral nutrition in both groups. Data were expressed as mean ～ standard deviation and SPSS13 was used for statistical analysis. ANOVA was used to determine statistical significance between treatments. A value of P 〈 0.05 was considered significant. Results Patients receiving MSCs treatment had no special discomfort or adverse drug reactions. The MMSE and Barthl scores in the treatment group were significantly higher than those in the control group （MMSE： 94.35 ± 12.56 vs 3.24 ±2.32, t = 27.6288, P = 0.000; Barthl： 93.60± 13.36 vs 6.39 ± 6.80, t = 22.3845, P = 0.000）. More patients in the in the treatment group recovered compared with the control group as indicated by imaging（76.47 %vs 26.66 %, χ^2 = 4.402, P = 0.0359）. Conclusion The carotid and intrathecal injection of MSCs had significantly improved effects on the treatment of DEACMP.