目的 评估脐带间充质干细胞(umbilical cord mesenchymal stem cells, UC-MSCs)移植治疗不完全性颈髓损伤的疗效和安全性。方法 对39例不完全性颈髓损伤患者进行4次鞘内UC-MSCs移植术, 术前及术后6个月应用美国脊髓损伤协会(American Spinal Injury Association, ASIA)制定的神经功能评分标准、日常生活活动能力评分标准(Barthel指数评分),对患者移植前后运动、感觉功能、肌张力及日常生活活动能力的改善情况进行评估。记录治疗期间的不良反应。结果 干细胞移植后6个月,患者感觉、运动功能、肌张力及日常生活活动能力,与术前相比均具有统计学差异,其中运动功能方面改善最为明显,ASIA评分治疗前61±22,治疗后70±18。均未发生术区感染、脑脊液漏、中枢神经系统感染等并发症,但有6例(15.4%)于术后24 h内出现发热,3例(7.7%)术后出现低颅压症状,2例(5.1%)术后出现腰部及下肢疼痛、麻胀感。结论 UC-MSCs鞘内移植可以改善不完全性颈髓损伤患者的感觉、运动、二便及自主神经功能等多方面的神经缺失症状,疗效较理想且安全。
Abstract
Objective To study the therapeutic effect of umbilical cord mesenchymal stem cell (UC-MSC) transplantation on incomplete cervical spinal cord injury. Methods 39 patients with incomplete cervical spinal cord injury were enrolled and received 4 times of UC-MSC transplantation through the pathways of lumbar puncture. ASIA scores and the Barthel index of activities of daily living (ADL) were used to assess the motion and sensory function, musclar tention, and activities of daily living of spinal cord patients before and half a year after the transplantation. Results The patients had improvement in their motion function, sensory function, musclar tention, and activities of daily living. And the most significant improvement was motor function, the scores changed from 61±22 before operation to 70±18 at 6 month after the transplantation. No obvious adverse reactions occurred, such as surgical site infection, cerebrospinal fluid leakage and central nervous system infection, etc. 15.4% of patients experienced fever in 24 hours after operation, 7.7% of patients experienced low intracranial pressure and 5.1% of patients experienced flank and lower limber pain. Conclusions UC-MSC transplantation significantly improves the sensory function, motion function, function of urination and defecation and perspiration in patients with incomplete cervical spinal cord injury with few adverse reactions.
关键词
脐带间充质干细胞 /
脊髓损伤 /
细胞移植
Key words
umbilical cord mesenchymal stem cell /
spinal cord injury /
cell transplantation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 郝春霞, 李建军, 周红俊, 等. 1264例住院脊髓损伤患者的流行病学分析[J]. 中国康复理论与实践, 2007, 13(11):1011-1013.
[2] Sekhon L H S, Fehlings M G. Epidemiology, demographics, and pathophysiology of acute spinal cord injury [J]. Spine, 2001,26(24):2-12.
[3] Deda H, Inci M C, Kurekci A E, et al. Treatment of chronic spinal cord injured patients with autologous bone marrow-derived hematopoietic stem cell transplantation:1-year follow-up[J]. Cytotherapy, 2008,10(6):565-574.
[4] Dai G H, Liu X B, Zhang Z, et al. Comparative analysis of curative effect of CT-guided stem cell transplantation and open surgical transplantation for sequelae of spinal cord injury [J]. J Transl Med, 2013,11:315-325
[5] Cheng H B, Liu X B, Hua R R, et al. Clinical observation of umbilical cord mesenchymal stem cell transplantation in treatment for sequelae of thoracolumbar spinal cord injury[J]. J Transl Med, 2014,12(1):253-263.
[6] 魏立友,申元英. 脊髓损伤的程度评价及流行病学现状[J]. 健康基础理论研究, 2009, 29(5):391-396.
[7] 孟祥琨,赵廷宝. 脐带间充质干细胞治疗脊髓损伤的研究现状[J]. 中国矫形外科杂志, 2011,19(6):485-487.
[8] Bradshaw H B, Rimmerman N, Krey J F, et al. Sex and hormonal cycle differ-ences in rat brain levels of pain-related cannabimimetic lipid mediators [ J]. Am J PhysiolRegul IntegrComp Physiol, 2006,291(2):349-358.
[9] An Y H, Tsang K S, Zhang H. Potential of stem cell based therapy and tissue engineering in the regeneration of central nervous system [J]. Biomed Mater, 2006,1(2):R38-R44.
[10] Sun C R, Wang C C, Tsang K S, et al. Modulation and impact of class I major histocompatibility complex by neural stem cell-derived neurotrophins on neuroregeneration [J]. Med Hypotheses, 2007,68(1):176-179.
[11] Sun L, Wang D, Liang J, et al. Umbilical cord mesenchymal stem cell transplantation in severe and refractory systemic lupus erythematosus [J]. Arthritis Rheum,2010,62(8):2467-2475.
[12] Tysseling-Mattiace V M, Sshni V, Niece K L, et al. Self-assembling nanofibers inhibit glial scar formation and promote axon elongation after spinal cord injury[J]. J Neurosci, 2008,28(14):3814-3823.
[13] Wu K H, Yang S G, Zhou B, et al. Human umbilical cord derived stem cells for the injured heart [J]. Med hypoth, 2007, 68(1): 94-97.
[14] Alberti E, Los M, Garcia R, et al. Prolonged survival and expression of neural markers by bone marrow-derived stem cells transplanted into brain lesions [J]. Med Sci Monit, 2009,15(2):BR47-54.
[15] Peru R L, Mandrycky N, Nait-Oumesmar B, et al. Paving the axonal highway: from stem cells to myelin repair [J]. Stem Cell Rev, 2008,4(4):304-318.
[16] Alenxanian A R, Mainman D J, Kurpad S N, et al. In vitro and in vivo characterization of neurally modified mesenchymal stem cells induced by epigenetic modifiers and neural stem cell environment [J]. Stem Cells Dev, 2008,17(6):1123-1130.
[17] Substrate K, Keung A J, Irwin E F, et al. Substrate modulus directs neural stem cell behavior [J]. Biophys J, 2008,95(9):4426-4438.
[18] Xuan A G, Long D H, Gu H G, et al. BDNF improves the effects of neural stem cells on the rat model of Alzheimer’s disease with unilateral lesion of fimbria-fornix [J]. Neurosci Lett, 2008,440(3):331-335.
[19] Sasaki H, Ishikawa M, Tanaka N, et al. Administration of human peripheral blood-derived CD133+ cells accelerates functional recovery in a rat spinal cord injury model [J]. Spinal, 2009,34(3):249-254.
[20] Oz Oyar E, Kardes O, Korkma A, et al. Effects of vascular endothelial growth factor on ischemic spinal cord injury caused by aortic cross-clamping in rabbits[J]. J Surg Res, 2009,151(1):94-99.
[21] Hess D C, Borlongan C V. Stem cells and neurological diseases [J]. Cell Prolif, 2008,41(Suppl 1):94-114.
[22] Walker T L, White A, Black D M, et al. Latent stem and progenitor cells in the hippocampus are activated by neural excitation [J]. J Neurosci, 2008,28(20):5240-5247.
[23] Walker P A, Harting M T, Shah S K, et al. Progenitor cell therapy for the treatment of central nervous system injury: a review of the state of current clinical trials [J]. Stem Cells Int, 2010,2010(20):1-8.
PDF(792 KB)
