骨髓间充质干细胞与骨髓单个核细胞治疗脑性瘫痪的疗效比较

Bone marrow mesenchymal stem cells versus bone marrow mononuclear cells for treating cerebral palsy

背景:骨髓间充质干细胞和骨髓单个核细胞都可以治疗脑性瘫痪。然而,这两者的疗效差异仍不清楚。目的:对比骨髓间充质干细胞以及骨髓单个核细胞对于脑性瘫痪患儿粗大及精细运动功能的治疗作用。方法:招募105例脑性瘫痪患儿并随机分配成3组:骨髓间充质干细胞组、骨髓单个核细胞组以及对照组。th骨髓间充质干细胞组和骨髓单个核细胞组患儿均接受4次腰椎穿刺细胞移植,对照组采用Boba法进行治疗,2 d治疗1次,持续3周。在治疗3,6,12个月后使用粗大运动量表和精细运动量表对各组患儿的粗大运动和精细运动功能进行量化评价。结果与结论:(1)移植治疗后3个月,骨髓间充质干细胞组GMFM评分A功能区和FMFM评分A、C功能区得分均优于骨髓单个核细胞组和对照组(P<0.05);(2)移植治疗后6个月,骨髓间充质干细胞组GMFM评分A、B功能区得分及总分,FMFM评分A、B、C、D、E功能区得分及总分均优于骨髓单个核细胞组和对照组(P<0.05);(3)移植治疗后12个月,骨髓间充质干细胞组GMFM评分A、B、C功能区得分及总分,FMFM评分A、B、C、D、E功能区得分及总分均优于其他两组(P<0.05);(4)骨髓单个核细胞组和骨髓间充质干细胞组患儿分别有6例出现低颅压性头痛、6例出现低热;(5)结果表明,骨髓间充质干细胞和骨髓单个核细胞移植治疗小儿脑性瘫痪安全、有效、可行,骨髓间充质干细胞相较骨髓单个核细胞及康复治疗,无论在粗大运动还是精细运动功能方面都有显著优势。

BACKGROUND:Bone marrow mesenchymal stem cells(BMSCs)and bone marrow mononuclear cells(BMMNCs)have been both used to treat spastic cerebral palsy.However,the differences in their therapeutic effects remain unknown.OBJECTIVE:To compare the therapeutic effects of BMMSCs and BMMNCs in cerebral palsy children as well as on fine motor function.METHODS:105 children with spastic cerebral palsy were enrolled and randomly assigned to three groups:BMMSCs group,BMMNCs group and control group.Patients in the two transplantation groups received four intrathecal cell injections,and those in the control group received Bobath therapy,twice a day,for consecutive 3 weeks.The Gross Motor Function Measure(GMFM)and Fine Motor Function Measure(FMFM)were used to evaluate the therapeutic efficacy at 3,6 and 12 months after transplantation.RESULTS AND CONCLUSION:At 3 months after cell transplantation,scores in A dimension of GMFM and in A,C dimensions of FMFM in BMMSC group were all superior to those of BMMNC group and control group(P<0.05).At 6 months after cell transplantation,scores in A,B dimensions of GMFM and in A,B,C,D and E dimensions of FMFM in BMMSC group were better than those of BMMNC group and control group(P<0.05),and total scores of GMFM and FMFM were also better in the BMMSC group(P<0.05).At 12 months after cell transplantation,scores in A,B and C dimensions of GMFM and A,B,C,D and E dimensions of FMFM scores in BMMSC group were all superior to those of BMMNC group and control group(P<0.05)as well as the total GMFM and FMFM scores.There were six cases of low intracranial pressure headache in BMMNC group and six cases of low-grade fever in BMMSC group.In summary,both BMMSCs transplantation and BMMNCs transplantation are safe,effective and feasible for the treatment of spastic cerebral palsy in children,and moreover,BMMSCs transplantation is a better method than BMMNCs transplantation to improve gross and fine motor functions of spastic cerebral palsy children.