CAJ | 학술논문

目的观察比较蛛网膜下隙注射和静脉注射两种途径移植自体骨髓间充质干细胞治疗早期脊髓损伤的近期有效性和安全性.方法 2006年11月至2010年3月收治早期脊髓损伤患者96例,采用随机数字表法分为三组,其中蛛网膜下隙移植组38例患者通过蛛网膜下隙注射方式行自体骨髓间充质干细胞移植,静脉移植组32例患者通过静脉注射方式行自体骨髓间充质干细胞移植,对照组26例仅给予常规治疗.分别于治疗前,治疗后1、3、6个月采用美国脊髓损伤协会(ASIA)制定的评分标准对三组患者运动、感觉功能进行评定.同期随访血常规、凝血功能、生化全项、肿瘤标记物.结果治疗后1个月,三组患者运动、感觉功能都有不同程度恢复,感觉功能恢复更为明显,各组间比较差异均无统计学意义(P＞0.05).治疗后3个月,三组患者运动功能评分均有所提高,各组间比较差异均无统计学意义(P＞0.05).蛛网膜下隙移植组和静脉移植组患者感觉功能评分[分别为(130.9±41.6)、(131.2±22.7)分]均显著提高,与同期对照组[(109.3±36.4)分]比较差异有统计学意义(P＜0.05),但蛛网膜下隙移植组和静脉移植组比较差异无统计学意义(P＞0.05).治疗后6个月,对照组患者运动、感觉功能评分均未出现明显提高；蛛网膜下隙移植组和静脉移植组患者仍有明显恢复,与同期对照组比较差异有统计学意义(P＜0.05)；蛛网膜下隙移植组感觉功能评分[(151.6±46.9)分]较同期静脉移植组[(134.6±40.7)分]有显著提高(P＜ 0.05).随访各项检查结果中均未出现明显异常.结论蛛网膜下隙注射和静脉注射两种途径进行自体骨髓间充质干细胞移植治疗早期脊髓损伤均安全,近期疗效确切,但蛛网膜下隙注射途径优于静脉注射途径,但远期疗效及安全性尚待进一步观察.
목적 관찰비교주망막하극주사화정맥주사량충도경이식자체골수간충질간세포치료조기척수손상적근기유효성화안전성.방법 2006년11월지2010년3월수치조기척수손상환자96례,채용수궤수자표법분위삼조,기중주망막하극이식조38례환자통과주망막하극주사방식행자체골수간충질간세포이식,정맥이식조32례환자통과정맥주사방식행자체골수간충질간세포이식,대조조26례부급여상규치료.분별우치료전,치료후1、3、6개월채용미국척수손상협회(ASIA)제정적평분표준대삼조환자운동、감각공능진행평정.동기수방혈상규、응혈공능、생화전항、종류표기물.결과 치료후1개월,삼조환자운동、감각공능도유불동정도회복,감각공능회복경위명현,각조간비교차이균무통계학의의(P＞0.05).치료후3개월,삼조환자운동공능평분균유소제고,각조간비교차이균무통계학의의(P＞0.05).주망막하극이식조화정맥이식조환자감각공능평분[분별위(130.9±41.6)、(131.2±22.7)분]균현저제고,여동기대조조[(109.3±36.4)분]비교차이유통계학의의(P＜0.05),단주망막하극이식조화정맥이식조비교차이무통계학의의(P＞0.05).치료후6개월,대조조환자운동、감각공능평분균미출현명현제고；주망막하극이식조화정맥이식조환자잉유명현회복,여동기대조조비교차이유통계학의의(P＜0.05)；주망막하극이식조감각공능평분[(151.6±46.9)분]교동기정맥이식조[(134.6±40.7)분]유현저제고(P＜ 0.05).수방각항검사결과중균미출현명현이상.결론 주망막하극주사화정맥주사량충도경진행자체골수간충질간세포이식치료조기척수손상균안전,근기료효학절,단주망막하극주사도경우우정맥주사도경,단원기료효급안전성상대진일보관찰.
Objective To compare the short-term efficacy and safety of autologous bone marrow mesenchymal stem cells transplantation on patients with early spinal cord injury by subarachnoid injection and by intravenous injection.Methods Ninety-six patients with early spinal cord injury were hospitalized and treated from November 2006 to March 2010.Thirty-eight cases (subarachnoid transplantation group) got transplantation by subarachnoid injection,32 cases (intravenous transplantation group) got transplantation by intravenous injection,26 cases (control group) were hospitalized in the same period but not transplanted.The motor and sensory functions of all three groups were evaluated according to the score standard developed by American Spinal Injury Association (ASIA) before treatment and at the first,the third,the sixth month after treatment.Meanwhile,routine blood test,coagulation,biochemical items and tumor markers were also examined in follow-up.Results The motor and sensory function of three groups had different degree of recovery at the first month after treatment,and sensory function recovered much significantly,but the comparison among three groups had no statistical significance.The scores of motor function increased in three groups at the third month after treatment,but still had no statistical significance (P＞ 0.05).The scores of sensory function of subarachnoid transplantation group [(130.9 ±41.6) scores] and intravenous transplantation group [ (131.2±22.7 ) scores ] increased obviously,and had significant difference compared with control group [ (109.3±36.4) scores] (P ＜ 0.05),but there were no significant difference between subarachnoid transplantation group and intravenous transplantation group (P ＞ 0.05).The scores of sensory and motor function of control group didn't increase obviously at the sixth month after treatment,while the scores of subarachnoid transplantation group and intravenous transplantation group gradually improved and had statistical significance compared with control group(P ＜ 0.05).The scores of sensory function was higher in subarachnoid transplantation group[ (151.6±46.9) scores ] than that in intravenous ransplantation group [(134.6 ±40.7) scores] (P ＜0.05).There were no obvious abnormality in the results of followed-up examination.Conclusions The safety and short-term efficacy of autologous bone marrow mesenchymal stem cells transplantation in treating early spinal cord injury by subarachnoid injection and intravenous injection is certified.The subarachnoid injection is better than intravenous injection,but the long-term efficacy need furter study.