CAJ | 학술논문

背景:动物实验研究已证实,采用细胞移植、神经营养因子注入或移植等方法可改变损伤脊髓局部环境,促使损伤脊髓恢复部分功能.目的:开展嗅鞘细胞移植治疗脊髓炎后遗症的临床实验,观察其对脊髓损伤的恢复作用.设计:非随机自身对照.单位:山东省泰安荣军医院外二科病房.对象:选择2004-06/2007-07来源于全国各地的陈旧性脊髓炎患者32例,伤后时间为0.5～7年.患者经各种传统治疗及肢体功能锻炼后神经功能无明显改善,并遗留各种感觉运动及植物神经功能障碍.男21例,女11例,年龄5～48岁,急性病毒性脊髓炎18例,急性化脓性脊髓炎8例,结核性脊髓炎6例,发病后均曾给予大剂量甲基强地松龙、地塞米松、抗炎、抗免疫及各种神经营养药物治疗.26例临床表现均为完全性损伤.6例为不完全性损伤,患者对治疗知情同意,治疗方案经过医院伦理委员会批准.胚胎嗅球来自流产胚胎,由患者或家属自愿捐献.方法:取胚胎嗅球,经细胞分离、培养、纯化7～14 d,最后消化成单细胞混悬液,然后在手术显微镜下移植到患者损伤脊髓区域的上下方.术后2周～2个月,采用2000年美国脊髓损伤学会制定的ASIA评分标准进行术后评定,并进行手术前后对比.主要观察指标:①感觉功能变化.②运动功能变化.结果:嗅鞘细胞移植术后0.5-2年,32例患者感觉和运动功能均有明显改善(运动功能:51.53±13.41,55.72±10.50;轻触觉:63.06±15.98,69.53±11.68;疼痛觉:64.03±15.01,69.50±12.20,P均＜0.01).结论:嗅鞘细胞移植能够有助于脊髓炎后遗症患者的神经功能恢复,但长期疗效有待于进一步观察.
배경:동물실험연구이증실,채용세포이식、신경영양인자주입혹이식등방법가개변손상척수국부배경,촉사손상척수회복부분공능.목적:개전후초세포이식치료척수염후유증적림상실험,관찰기대척수손상적회복작용.설계:비수궤자신대조.단위:산동성태안영군의원외이과병방.대상:선택2004-06/2007-07래원우전국각지적진구성척수염환자32례,상후시간위0.5～7년.환자경각충전통치료급지체공능단련후신경공능무명현개선,병유류각충감각운동급식물신경공능장애.남21례,녀11례,년령5～48세,급성병독성척수염18례,급성화농성척수염8례,결핵성척수염6례,발병후균증급여대제량갑기강지송룡、지새미송、항염、항면역급각충신경영양약물치료.26례림상표현균위완전성손상.6례위불완전성손상,환자대치료지정동의,치료방안경과의원윤리위원회비준.배태후구래자유산배태,유환자혹가속자원연헌.방법:취배태후구,경세포분리、배양、순화7～14 d,최후소화성단세포혼현액,연후재수술현미경하이식도환자손상척수구역적상하방.술후2주～2개월,채용2000년미국척수손상학회제정적ASIA평분표준진행술후평정,병진행수술전후대비.주요관찰지표:①감각공능변화.②운동공능변화.결과:후초세포이식술후0.5-2년,32례환자감각화운동공능균유명현개선(운동공능:51.53±13.41,55.72±10.50;경촉각:63.06±15.98,69.53±11.68;동통각:64.03±15.01,69.50±12.20,P균＜0.01).결론:후초세포이식능구유조우척수염후유증환자적신경공능회복,단장기료효유대우진일보관찰.
BACKGROUND: Animal experimental studies have confirmed that cell transplantation, neurotrophic factor infusion or transplantation as well as other methods can alter the local environment of injured spinal cord and promote its partial function recovery.OBJECTIVE: This study aimed to assess the clinical efficacy of olfactory ensheathing cell transplantation for the treatment of the sequel of myelitis, and to explore whether it would promote the recovery of the spinal cord function.DESIGN: A non-randomized self-control study.SETTING: Ward of Second Department of Surgery of Taian Disabled Soldiers Hospital of Shandong Province.PARTICIPANTS: Thirty-two patients with obsolete myelitis, who come from all over China and suffered from disease for 0.5 to 7 years, admitted to our hospital between June 2004 and July 2007 were recruited in this study. The involved patients, including 21 males and 11 females, were aged 5-48 years. Their neurological functions were not obviously improved after various conventional treatments and limb function exercise. Meanwhile, various sensorimotors and autonomic nerve functional impairments were left. Among the patients, 18 suffered from acute viral myelitis, 8 from acute purulent myelitis and 6 from tuberculous myelitis. After onset, they were all given large doses of radiosonde,dexamethasone, anti-inflammatory and immunomodulatory drugs and various neurotrophic drugs. Twenty-six patients presented complete injury and six patients incomplete injury. Informed consent of treatment was obtained from each patient. The therapeutic protocol was approved by the Ethics Committee of the hospital. Embryonic olfactory bulbs were harvested from aborted embryo, which was donated voluntarily by the patients or their relatives.METHODS: Cells were isolated from embryonic olfactory bulbs, cultured and purified for 7 to 14 days, and finally they were digested into single-cell suspension. Under the surgical miscroscope, the cells were transplanted onto the regions which were above or below the spinal cord injury site. Two weeks to 2 months postoperatively, neurological function of spinal cord was assessed by using the American Spinal Injury Association (ASIA) Scoring Standard formulated in 2000, and was compared to pre-operation function.MAIN OUTCOME MEASURES: ①Sensory function change. ②Motor function change.RESULTS: Half a year to 2 years after olfactory ensheathing cell transplantation, the sensory and motor functions of 32 patients were all obviously improved (motor function: 55.72±10.50 vs. 51.53±13.41; light touch:69.53±11.68 vs.63.06±15.98; pain sense: 69.50±12.20 vs. 64.03±15.0, all P ＜ 0.01 ).CONCLUSION: Olfactory ensheathing cell transplantation can help to promote the neurological function recovery of patients with the sequel of myelitis. However, its long-term curative effect needs to be further investigated.