骨髓单个核细胞联合颅内外血管搭桥术治疗烟雾病的疗效观察

Observation on the effect of bone marrow mononuclear cells combined with extracranial-intracranial bypass surgery in the treatment of moyamoya disease

目的研究骨髓单个核细胞联合颅内外血管搭桥治疗烟雾病的临床效果,以及对血清炎症因子C反应蛋白(CRP)、白介素-10(IL-10)的影响。方法收集2015-05—2017-05河南大学第一附属医院收治的烟雾病患者84例,按照数字表法将其随机分为对照组与研究组各42例,对照组实施直接颅内外血管搭桥手术,研究组在对照组基础上加用骨髓单个核细胞治疗,其他综合治疗相同,分别记录治疗前后2组的NIHSS评分、脑血流变化情况、血清CRP与IL-10水平及术后并发症情况。比较2组治疗前后NIHSS评分、脑血流、血清CRP与IL-10水平变化及并发症情况。结果治疗前,2组NIHSS评分比较、血清CRP与IL-10水平无明显差异(P>0.05);治疗后,研究组NIHSS(28.42±1.53)分,脑脉压差(31.13±0.78)、血流量(13.97±1.34),以及血流峰值(157.45±2.76)、血清CRP(37.05±3.12),IL-10(56.33±8.72),对照组NIHSS(28.42±1.53)分,脑脉压差(31.04±0.98)、血流量(13.23±0.99),以及血流峰值(156.28±1.27),血清CRP(44.62±4.21),IL-10(68.03±7.84)。研究组NIHSS评分明显低于对照组(P<0.05),研究组CRP和IL-10水平均显著低于对照组(P<0.05);研究组治疗后的脑脉压(灌注)差、血流量以及血流峰值与对照组无明显差异(P>0.05),研究组的并发症发生率为7.14%,明显低于对照组并发症发生率21.43%(P<0.05)。结论对烟雾病患者采用骨髓单个核细胞联合颅内外血管搭桥治疗效果优于颅内外血管搭桥,可有效改善患者神经功能缺损及脑血流供应,降低血清CRP、IL-10炎症因子的表达,不良反应少,值得推广。

Objective To study the clinical effect of bone marrow mononuclear cells combined with extracranial intracranial bypass surgery in the treatment of moyamoya disease and the impact on serum inflammatory factor C reactive protein（CRP） and interleukin 10（IL 10）. Methods 84 patients with moyamoya disease from May 2015 to May 2017 admitted in our hospital were enrolled and randomly divided into two groups：control group（ n =42） and control group（ n =42）.The control group was treated with extracranial intracranial bypass surgery,and the study group was treated with bone marrow mononuclear cells on the basis of the control group.The neurological deficit（NIHSS） scores,complications,changes of cerebral blood flow and serum levels of CRP and IL 10 before and after treatment were recorded between the two groups.We compared the NIHSS score,cerebral blood flow,serum CRP and IL 10 levels and complications between the two groups before and after treatment. Results There was no significant difference in NIHSS scores,serum CRP and IL 10 levelsbetween the two groups before treatment（ P 〉0.05）,but after treatment,NIHSS（28.42±1.53）,cerebral pulse pressure（31.13±0.78） and blood flow（13.97±1.34）,blood flow peak（157.45±2.76）,serum CRP（37.05±3.12）,IL 10（56.33±8.72） were measured in the study group.In the control group,NIHSS（28.42±1.53）,cerebral pulse pressure difference（31.04±0.98） and blood flow（13.23±0.99） and blood flow peak（156.28±1.27）,serum CRP（44.62±4.21）,IL 10（68.03±7.84）were measured.The scores of NIHSS and the levels of CRP and IL 10 in the study group were significantly lower than those in the control group（ P 〈0.05）.There was no significant difference in cerebral pulse pressure（perfusion）,blood flow and peak blood flow between the study group and the control group（ P 〉0.05）.The incidence of complications in the study group was 7.14%,which was significantly lower than that in the control group（21.43%）（ P 〈0.05）. Conclusion Bone marrow mononuclear cells combined with extracranial intracranial bypass surgery effective in the treatment of Moyamoya disease.It can effectively improve the neurological function and cerebral blood supply of patients and reduce the expression of serum CRP and IL 10 inflammatory factors.This therapy is safe and reliable with few complications,and is worth clinical promotion.