嗅鞘细胞移植改善晚期脊髓损伤患者神经功能的近期效应
후초세포이식개선만기척수손상환자신경공능적근기효응
Short-term effect of olfactory ensheathing cells transplantation on the improvement of neurological functions in patients with chronic spinal cord injury
  • 万方数据
    中国临床康复 중국림상강복
    CHINESE JOURNAL OF CLINICAL REHABILITATION
    2006年 13期 190-192 ,共3页

    黄红云%陈琳%王洪美%张健%张峰%刘彦铖%郗海涛%顾征%宋英伦%李荧%谭可%修波%王锐%苟成青

    황홍운%진림%왕홍미%장건%장봉%류언성%치해도%고정%송영륜%리형%담가%수파%왕예%구성청

    嗅鞘细胞%脊髓损伤%移植 嗅鞘細胞%脊髓損傷%移植
    후초세포%척수손상%이식
    背景:既往认为中枢神经无再生能力.但近年来研究发现,脊髓损伤后,改变局部环境,损伤的神经轴突可以有再生能力并能恢复部分神经功能.目的:探讨胚嗅鞘细胞移植治疗晚期脊髓损伤患者是否安全、可行和有效恢复神经功能.设计:自身前后对照观察.单位:北京西山医院神经疾病研究治疗中心、首都医科大学附属北京朝阳医院神经外二科和解放军海军总医院神经外二科.对象:选择2001-11/2003-02首都医科大学附属北京朝阳医院神经外二科和海军总医院神经外二科治疗的晚期脊髓损伤患者171例.其中完全性损伤147例,不全性损伤24例.伤后时间:0.5～18年.治疗过程经有关医疗伦理委员会讨论同意,细胞捐献者自愿同意,被治疗者知情同意.方法:①取胚胎嗅球,消化成单个嗅鞘细胞后培养12～17 d.②将胚胎嗅鞘细胞移植到患者脊髓损伤部位的上下处.③所有患者在胚胎嗅鞘细胞移植手术前和手术后2～8周按美国脊髓损伤学会(ASIA)评分标准评价.主要观察指标:①嗅鞘细胞移植术后患者脊髓功能恢复情况.②不良事件及副反应.结果:171例患者全部进入结果分析.①嗅鞘细胞移植术后患者脊髓功能恢复情况:171例均有部分神经功能快速恢复,其中运动功能评分由术前34.5±20.3提高到42.0±20.0(P＜0.001),轻触觉评分由术前47.2±24.0提高到61.8±23.0(P＜0.001),痛觉评分由术前48.6±23.5提高到64.0±22.8(P＜0.001).②不良事件及副反应:1例术区感染导致脊髓损害表现早期加重;2例严重肺部感染,1例丘脑出血,此3例患者最终因严重呼吸、循环衰竭而死亡.结论:嗅鞘细胞移植能快速促进晚期脊髓损伤患者恢复部分神经功能,但作用机制尚需进一步观察.
    배경:기왕인위중추신경무재생능력.단근년래연구발현,척수손상후,개변국부배경,손상적신경축돌가이유재생능력병능회복부분신경공능.목적:탐토배후초세포이식치료만기척수손상환자시부안전、가행화유효회복신경공능.설계:자신전후대조관찰.단위:북경서산의원신경질병연구치료중심、수도의과대학부속북경조양의원신경외이과화해방군해군총의원신경외이과.대상:선택2001-11/2003-02수도의과대학부속북경조양의원신경외이과화해군총의원신경외이과치료적만기척수손상환자171례.기중완전성손상147례,불전성손상24례.상후시간:0.5～18년.치료과정경유관의료윤리위원회토론동의,세포연헌자자원동의,피치료자지정동의.방법:①취배태후구,소화성단개후초세포후배양12～17 d.②장배태후초세포이식도환자척수손상부위적상하처.③소유환자재배태후초세포이식수술전화수술후2～8주안미국척수손상학회(ASIA)평분표준평개.주요관찰지표:①후초세포이식술후환자척수공능회복정황.②불량사건급부반응.결과:171례환자전부진입결과분석.①후초세포이식술후환자척수공능회복정황:171례균유부분신경공능쾌속회복,기중운동공능평분유술전34.5±20.3제고도42.0±20.0(P＜0.001),경촉각평분유술전47.2±24.0제고도61.8±23.0(P＜0.001),통각평분유술전48.6±23.5제고도64.0±22.8(P＜0.001).②불량사건급부반응:1례술구감염도치척수손해표현조기가중;2례엄중폐부감염,1례구뇌출혈,차3례환자최종인엄중호흡、순배쇠갈이사망.결론:후초세포이식능쾌속촉진만기척수손상환자회복부분신경공능,단작용궤제상수진일보관찰.
    BACKGROUND: It was thought that there was no regeneration capacity in central nerves. Recent research shows that regeneration capacity of injured neural axons and recovery of some neurological functions can be achieved by changing local surroundings after spinal cord injury (SCI).OBJECTIVE: To probe into whether the transplantation of fetal olfactory ensheathing cells (OECs) in recovering the neurological functions of patients with chronic SCI is safe, feasible, and effective.DESIGN: Auto-control observation before and after surgery.SETTING: Neurological Research and Treatment Center of Beijing Xishan Hospital; Second Department of Neurosurgery in Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences; Second Department of Neurosurgery in Naval General Hospital.PARTICIPANTS: A total of 171 patients with chronic spinal cord injury were selected from the Second Department of Neurosurgery in Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences and the Second Department of Neurosurgery in Naval General Hospital betweenNovember 2001 and February 2003, of which there are 147 patients with complete injury and 24 ones with incomplete injury. Post-injury period ranged from 0.5 to 18 years. Process of treatment is discussed and permitted by relevant Medical Ethics Committees. Cells were obtained from voluntary donors and patients agreed to receive the treatment.METHODS: ① Fetal olfactory bulbs were cultured for 12-17 days after being digested into single cells. ② Fetal OECs were transplanted into sites rostral and caudal to the epienter. ③ Neurological functions of all patients 2-8 weeks before and after operation were evaluated according to the scoring standard of ASIA.MAIN OUTCOME MEASURES: ① Status of functional recovery in spinal cord of patients after transplantation of OECs. ② Harmful events and side effects.RESULTS: A total of 171 patients were involved in the analysis of results.①Status of functional recovery in spinal cord of patients with OECs transplantation: Partial neurological functions of 171 patients rapidly recovered,whose motor function score increased from (34.5±20.3) points before operation to (42.0±20.0) points (P ＜ 0.001) after operation, score of light touch increased from (47.2±24.0) points to (61.8±23.0) points (P ＜ 0.001) after operation,score of pain sense increased from (48.6±23.5) points to (64.0±22.8) points (P ＜ 0.001). ②Harmful events and side-effects: Early manifestations of spinal cord injury induced by infection in surgical area of one patient aggravated; two patients suffered from serious pulmonary infection,one patient from thalamic hemorrhage. Three patients mentioned above died of serious respiration and circulatory failures.CONCLUSION: OEC transplantation can rapidly promote partial neurological function of patients with chronic SCI, while the mechanism needs further observing.
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