脐带间充质干细胞治疗产后盆底功能缺陷的初步临床研究

A preliminary clinical study on the treatment of postpartum pelvic floor dysfunction with umbilical cord mesenchymal stem cell

目的:探讨人脐带间充质干细胞(huCMSCs)复合富血小板血浆(PRP)盆底肌多点注射治疗产后盆底功能缺陷的疗效。方法:选择2017年10月至2018年10月在临沂市妇幼保健院已完成产后盆底康复训练,但恢复效果不佳的二胎及以上经阴分娩高龄女性10例,行异体huCMSCs复合PRP盆底肌多点注射治疗。比较治疗前及治疗后1年其静息、缩肛、Valsava三种状态下盆隔裂孔面积、盆底Ⅰ类和Ⅱ类肌纤维的肌力分布及阴道收缩压变化,并进行问卷调查,了解满意度及整体印象改善度(PGI-I)评分。结果:盆隔裂孔面积治疗后静息状态较治疗前显著变小(P<0.05),治疗前后盆底Ⅰ类、Ⅱ类肌纤维肌力分布差异有统计学意义(P<0.01),肌力明显增加;治疗后阴道收缩压力除1例外均有不同程度增加,整体呈现上升趋势,治疗前后阴道收缩压明显升高,差异有统计学意义(P<0.05);治疗后CD3、CD4、CD4/8、B细胞、NK细胞等淋巴细胞亚群无明显变化(P>0.05);治疗后满意度评分较治疗前明显改善(4.61±0.42 vs 2.13±0.45,P<0.05),PGI-I评分为6.47±0.25。结论:huCMSCs复合PRP盆底肌多点注射治疗对产后盆底功能缺陷具有治疗作用,且无免疫原性,是治疗产后盆底功能缺陷安全、微创、有效的治疗办法。

Objective:To investigate the prospective effect of human umbilical cord mesenchymal stem cell(huCMSCs)combined with platelet-rich plasma(PRP)multi point injection in the treatment of postpartum pelvic floor dysfunction.Methods:From Oct.2017 to Oct.2018,10 elderly women after vaginal delivery,who had completed the training of postpartum pelvic floor rehabilitation in Linyi Maternal and Child Health Care Hospital were selected to use huCMSCs and PRP,multi-point injection into the pelvic floor.Before and 1 year after treatment,the levator hiatus area,the distribution of typeⅠand TypeⅡmuscle fibers in the pelvic floor and the change of vaginal systolic pressure were compared under the three conditions of rest,contraction of anus and Valsava.Understanding satisfaction and overall impression improvement PGI-I score.Results:After treatment,the levator hiatus area in resting state became smaller than before treatment(P<0.05).There was significant difference in the distribution of typeⅠand TypeⅡmuscle fibers in the pelvic floor before and after treatment(P<0.01).There were no significant changes in the subpopulations of CD3,CD4,CD48,Bcell and NK cells(P>0.05),and after treatment,the satisfaction score was significantly improved(2.13±0.45 vs 4.61±0.42,P<0.05),PGI-I score was 6.47±0.25.Conclusion:The therapy of multiple injections of huCMSCs and PRP into pelvic floor musclesto treatment of postpartum pelvic floor dysfunction is a safe and effective method for the treatment of postpartum pelvic floor dysfunction.