中国修复重建外科杂志

中国修复重建外科杂志

嗅鞘细胞移植治疗中枢神经系统疾病1 255 例临床分析

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目的 总结嗅鞘细胞(olfactory ensheathing cells,OECs)移植治疗中枢神经系统疾病的临床价值。 方法 2001 年11 月- 2008 年1 月,收治1 255 例中枢神经系统疾病。男928 例,女327 例;年龄1.2 ~ 87 岁,平均40 岁;病程(4.52 ± 4.67)年。其中晚期脊髓损伤656 例,肌萎缩侧索硬化457 例,脑性瘫痪68 例,多发性硬化20 例,脑卒中后遗症11 例,共济失调10 例,其他疾病33 例。患者来自71 个国家或地区。均以自愿捐赠的意外流产健康胚胎嗅球培养的OECs 植入治疗。 结 果 1 128 例获随访2 ~ 8 周,平均4 周,其中994 例神经功能获不同程度改善,近期总改善率为88.12%。围手术期并发症共76 例,发生率为6.74%。随访超过1 年的脊髓损伤患者共120 例,按ASIA 标准评价:国外患者组运动功能由(39.82 ± 20.25)分提高至(44.55 ± 18.99)分,轻触觉由(51.56 ± 25.89)分提高至(59.81 ±27.72)分,痛觉由(50.36 ± 27.44)分提高至(57.09 ± 28.51)分,差异均有统计学意义(P lt; 0.05);国内康复训练良好患者组运动功能由(40.52 ± 20.80)分提高至(46.45 ± 20.35)分,轻触觉由(55.64 ± 26.32)分提高至(68.64 ± 25.89)分,痛觉由(57.05 ± 26.00)分提高至(66.13 ± 24.29)分,差异均有统计学意义(P lt; 0.05);国内康复训练不佳患者组运动功能由(37.03 ± 18.52)分提高至(38.03 ± 18.50)分(P lt; 0.05),轻触觉由(45.88 ± 22.56)分提高至(46.63 ± 23.09)分(P gt; 0.05),痛觉由(45.25 ± 23.68)分提高至(45.28 ± 23.63)分(P gt; 0.05)。国外患者组、国内康复训练良好患者组与国内康复训练不佳患者组各项指标比较,差异均有统计学意义(P lt; 0.05)。106 例肌萎缩侧索硬化、32 例脑性瘫痪、8 例多发性硬化、7 例共济失调患者分别获随访3 ~ 48、3 ~ 36、2 ~ 20、7 ~ 17 个月,2 例脑卒中后遗症患者分别获随访6、24 个月;其中113 例(72.9%)神经功能改善或病情稳定恶化趋势得到有效控制。 结论 OECs 脑内和/ 或脊髓内移植安全可行,能部分改善晚期脊髓损伤、肌萎缩侧索硬化、脑性瘫痪、脑卒中后遗症等中枢神经系统疾病患者的神经功能和/ 或延缓病情进行性恶化。

Objective To analyze the therapeutic effect of olfactory ensheathing cells (OECs) transplantation for central nervous system diseases. Methods Between November 2001 and January 2008, 1 255 participants with central nervous system diseases were enrolled in this cl inical study for fetal OECs transplantation. There were 928 males and 327 females
aged 1.2-87 (mean 40) years. The course of disease was (4.52 ± 4.67) years. Among them, 656 participants suffered from chronic spinal cord injury (SCI), 457 amyotrophic lateral sclerosis (ALS), 68 cerebral palsy (CP), 20 multiple sclerosis (MS), 11 the sequelae of stoke, 10 ataxia, and 33 residual diseases. The participants came from 71 countries or regions. Accidentally abortional fetal olfactory bulbs were donated voluntarily and were cultured for 2 weeks, then were transplanted. Results One thousand one hundred and twenty-eight cases were followed up for 2-8 weeks (mean 4 weeks) to obtain integrated data. Among them, the neurological functional amel ioration was noticed in 994 participants with the overall short-term improvement rate of 88.12%. Seventy-six patients experienced the various perioperative compl ications with the incidence rate of 6.74%. One hundred and twenty patients with SCI received over 1 year follow-up. And according to ASIA assessment, motor scores increased from (39.82 ± 20.25) to (44.55 ± 18.99) points, l ight touch scores from (51.56 ± 25.89) to (59.81 ± 27.72) points, pain scores from (50.36 ± 27.44) to (57.09 ± 28.51) points for foreign patients (P lt; 0.05); motor scores increased from (40.52 ± 20.80) to (46.45 ± 20.35) points, l ight touch scores from (55.64 ± 26.32) to (68.64 ± 25.89) points, pain scores from (57.05 ± 26.00) to (66.13 ± 24.29) points for good rehabil itation Chinese patients (overall P lt; 0.05); motor scores from (37.03 ± 18.52) to (38.03 ± 18.50 points (P lt;
0.05), l ight touch scores from (45.88 ± 22.56) to (46.63 ± 23.09) points (P gt; 0.05), pain scores from (45.25 ± 23.68) to (45.28 ± 23.63) points (P gt; 0.05) for poor rehabil itation Chinese patients. Compared foreign patients and good rehabil itation Chinese patients with poor rehabil itation Chinese patients, difference in score change was remarkable (P lt; 0.05). One hundred and six cases of ALS, 32 CP, 8 MS, 7 ataxia, and 2 stroke sequelae were followed up for 3-48, 3-36, 2-20, 7-17, 6 and 24 months, One hundred and six cases of respectively. Majority of them (113/155, 72.9%)were benefited from OECs transplantation. Conclusion OECs transplantation into brain and spinal cord is feasible and safe . The therapeutic strategy is valuable treatment for such central nervous system diseases such as chronic SCI, ALS, CP and stroke sequelae and can improve the patients’ neurological functions and/or decrease the progressive deterioration.

关键词: 中枢神经系统疾病; 嗅鞘细胞移植; 临床研究; 神经修复

Key words: Central nervous system disease; Olfactory ensheathing cells transplantation; Clinical research; Neurorestoration

引用本文: 黄红云,陈琳,郗海涛,王庆苗,张健,刘彦铖,张峰. 嗅鞘细胞移植治疗中枢神经系统疾病1 255 例临床分析. 中国修复重建外科杂志, 2009, 23(1): 14-20. doi: 复制

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