中国修复重建外科杂志
中國脩複重建外科雜誌
중국수복중건외과잡지
CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY
2007年
9期
961-966
,共6页
陈琳%黄红云%张健%张峰%刘彦铖%郗海涛%王洪美%顾征%宋英伦%李荧%谭可
陳琳%黃紅雲%張健%張峰%劉彥鋮%郗海濤%王洪美%顧徵%宋英倫%李熒%譚可
진림%황홍운%장건%장봉%류언성%치해도%왕홍미%고정%송영륜%리형%담가
肌萎缩侧索硬化症%胚胎嗅鞘细胞%移植
肌萎縮側索硬化癥%胚胎嗅鞘細胞%移植
기위축측색경화증%배태후초세포%이식
Amyotrophic lateral sclerosis%Olfactory ensheathing cells%Transplantation
目的 探讨人胚胎嗅鞘细胞(olfactory ensheathing cells,OECs)移植治疗肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)患者的近期安全性和有效性. 方法 回顾性分析2003年2月～2006年4月,采用OECs移植手术治疗的327例ALS患者的临床资料.男241例,女86例.年龄20～84岁(51.6±11.1岁).病程4.8个月～13年(2.9±2.0年).根据细胞植入部位分为3组:A组29例,细胞植入脊髓内;B组(6例),细胞分别植入脊髓及双额叶放射冠;C组292例,细胞植入双额叶放射冠.脊髓移植方法,病变处分两点共注入50 μl OECs悬液,细胞数约1×106个.脑部移植方法,双侧大脑放射冠处各注射50 μl OECs悬液,细胞数约2×106个. 结果 随访4周,比较术前和随访肌萎缩侧索硬化症功能量表分数变化.A组17.2±8.6增至20.1±9.7(P＜0.05),B组24.2±6.8增至25.7±6.6(P＞0.05),C组20.3±8.6增至22.0±9.4(P＜0.001),3组间改善程度差异无统计学意义(P＞0.05).4周神经功能总改善252例(77.1%).术后4周行肌电图检查的患者261例(79.8%)显示术后自发电位减少或消失,收缩时肌电波幅较术前明显降低,电位密度明显增加.16例(4.9%)术后出现不良反应,包括头痛、短期发热、癫痫大发作、中枢神经系统感染、肺炎、呼吸衰竭、泌尿系感染、心力衰竭及肺栓塞,其中4例(1.2%)死亡. 结论 OECs移植术后4周能阻止或逆转ALS的病情恶化.
目的 探討人胚胎嗅鞘細胞(olfactory ensheathing cells,OECs)移植治療肌萎縮側索硬化癥(amyotrophic lateral sclerosis,ALS)患者的近期安全性和有效性. 方法 迴顧性分析2003年2月～2006年4月,採用OECs移植手術治療的327例ALS患者的臨床資料.男241例,女86例.年齡20～84歲(51.6±11.1歲).病程4.8箇月～13年(2.9±2.0年).根據細胞植入部位分為3組:A組29例,細胞植入脊髓內;B組(6例),細胞分彆植入脊髓及雙額葉放射冠;C組292例,細胞植入雙額葉放射冠.脊髓移植方法,病變處分兩點共註入50 μl OECs懸液,細胞數約1×106箇.腦部移植方法,雙側大腦放射冠處各註射50 μl OECs懸液,細胞數約2×106箇. 結果 隨訪4週,比較術前和隨訪肌萎縮側索硬化癥功能量錶分數變化.A組17.2±8.6增至20.1±9.7(P＜0.05),B組24.2±6.8增至25.7±6.6(P＞0.05),C組20.3±8.6增至22.0±9.4(P＜0.001),3組間改善程度差異無統計學意義(P＞0.05).4週神經功能總改善252例(77.1%).術後4週行肌電圖檢查的患者261例(79.8%)顯示術後自髮電位減少或消失,收縮時肌電波幅較術前明顯降低,電位密度明顯增加.16例(4.9%)術後齣現不良反應,包括頭痛、短期髮熱、癲癇大髮作、中樞神經繫統感染、肺炎、呼吸衰竭、泌尿繫感染、心力衰竭及肺栓塞,其中4例(1.2%)死亡. 結論 OECs移植術後4週能阻止或逆轉ALS的病情噁化.
목적 탐토인배태후초세포(olfactory ensheathing cells,OECs)이식치료기위축측색경화증(amyotrophic lateral sclerosis,ALS)환자적근기안전성화유효성. 방법 회고성분석2003년2월～2006년4월,채용OECs이식수술치료적327례ALS환자적림상자료.남241례,녀86례.년령20～84세(51.6±11.1세).병정4.8개월～13년(2.9±2.0년).근거세포식입부위분위3조:A조29례,세포식입척수내;B조(6례),세포분별식입척수급쌍액협방사관;C조292례,세포식입쌍액협방사관.척수이식방법,병변처분량점공주입50 μl OECs현액,세포수약1×106개.뇌부이식방법,쌍측대뇌방사관처각주사50 μl OECs현액,세포수약2×106개. 결과 수방4주,비교술전화수방기위축측색경화증공능량표분수변화.A조17.2±8.6증지20.1±9.7(P＜0.05),B조24.2±6.8증지25.7±6.6(P＞0.05),C조20.3±8.6증지22.0±9.4(P＜0.001),3조간개선정도차이무통계학의의(P＞0.05).4주신경공능총개선252례(77.1%).술후4주행기전도검사적환자261례(79.8%)현시술후자발전위감소혹소실,수축시기전파폭교술전명현강저,전위밀도명현증가.16례(4.9%)술후출현불량반응,포괄두통、단기발열、전간대발작、중추신경계통감염、폐염、호흡쇠갈、비뇨계감염、심력쇠갈급폐전새,기중4례(1.2%)사망. 결론 OECs이식술후4주능조지혹역전ALS적병정악화.
Objective To determine whether transplanting olfactory ensheathing cells(OECs)is effective in controlling or re.versing the deterioration caused by amyotrophic lateral sclerosis(AtS). Methods Uetwcen February 2003 and April 2006,327 pa-fients(241 males and 86 females)with probable or definite ALS(diagnosed according to the El Escorial criteria)received dle oECstransplantation.Their ages ranged from 20 to 84 years(51.6±11.1 years).The duaration of sympltoms before surgical trealment wit84.8months to 13 years(2.9±2.0 years).OECs were cultured and.injected into palllological regions of the spinal cord and/or bilateralcoroila radiata of the brain;the patients were divided into three groups,group A(cord only,n=29),group B(cord and brain,,n=6),and group C(brain only,n=292)based on the transplant sites. Results The patient's neurological function was assessedboth before and at4 weeks after transplantation by using the Amyolrophic Lateral Sclerosis Functional Rating Scale(ALSFRS)of the ALSCNTF Trealment Study(ACTS).The$cores were increased from 17.2±8.6 pre-operation to 20.1±9.7 post-operation in group A(P<0.05),from 24.2 4-6.8 to 25.7±6.6(P>0.05)in group B,and from 20.3±8.6 to 22.0±9.4(P<0.001)in group C.There were no significant difference inincreased ALSFRS scores amongthe three groups(P>O.05).The total improvement rate of neurological function was 77.1%(252/327).The result of electramyographic examination showed that spontaneous potential diminishedand/or disappeared,the amplitude of the motor unit action potential decreased remarkably andthe numbers of motor unitaction potentialgreatly increased in 261 cases(79.8%).Sixteen patients(4.9%)experienced the various complications including headache.short-term fever,seizure attack,central nerve system infection,pneumonia,respiratory failure,urinary tract infection,heartfailure,and pos-sible pulmonary embolism;of them,there were 4 deaths(1.2%). Conclusion These preliminary results suggest that the OECs trasplantafion is effective in controlling or reversing the physiological deterioration caused by ALS.
