摘要
目的 评价嗅鞘细胞移植治疗脊髓损伤的长期临床安全性及疗效.方法 回顾性分析西安交通大学医学院第二附属医院2005 年9 月至2010 年3 月共24 例异体胚胎嗅球来源嗅鞘细胞移植治疗患者的临床资料.年龄19 ~ 45 岁（中位年龄32.4 岁）;其中男20 例,女4 例;不全瘫14 例,全瘫10 例.移植的嗅鞘细胞来源于引产胚胎嗅球,取材后培养7 ~ 10 d 进行移植,细胞浓度2 × 104/μl,免疫组化检测为P75 阳性嗅鞘细胞.注射细胞前所有病例均进行脊髓损伤段瘢痕组织松解,注射点选择在脊髓损伤区远、近端各约0.5 cm 处的脊髓后角处,进针深度约3 mm,注射细胞量约40 μl.术后常规处理,随访采用医院门诊复查方式,每3 个月观察患者损伤感觉平面的变化,损伤平面下肌肉肌力的变化,以及患者对于治疗效果的评价,并应用ASIA 评分了解神经功能变化情况.移植手术前后ASIA 评分比较采用随机区组方差分析.结果 24 例患者术后随访平均时间3.2 年（0.5 - 5.2年）.9 例全瘫患者术后感觉平面下降1 - 2 个脊髓节段,运动未见变化,1 例感觉平面未见变化.11 例不全瘫痪患者的感觉平面下降2 个节段,2 例患者下降3 个节段,其中1 例患者的屈指功能改进,并出现拇长伸肌的背伸运动,肌力为2 级.所有患者随访期间未发现明显的手术并发症,术后MRI 检查未发现移植局部的肿瘤空洞或形成.患者自身对其所获治疗效果评价：优2 例,良9 例,可12 例,差1 例;优良率：46 ﹪.手术前截瘫患者针刺觉分值为41.73 ± 27.07、轻触觉分值为40.18 ± 29.15,手术后分别为48.18 ± 24.89,47.09 ±27.03 ;随访期间为53.64 ± 26.08,47.09 ± 27.03,差异均有统计学意义（F = 7.71,4.56 ;P = 0.00,0.02）.结论 应用胚胎嗅球来源嗅鞘细胞移植治疗脊髓损伤患者的方法较安全,移植后患者临床症状获得不同程度改善.
Objective To evaluate the long term safety and efficacy of olfactory ensheathing cell transplantation （OECT） in the treatment of patients with spinal cord injury. Methods Twenty-four patients （male/female 20/4; average age 32.4 years, age range 19-45） were treated with allogeneic embryonic OECT in our hospital from September 2005 to March 2010. Thirteen patients were quadriplegia, 11 paraplegia, 14 incomplete paralysis, and 10 total paralysis. The olfactory ensheathing cells for transplantation were derived from embryonic olfactory bulb induction （cell concentration： 2×10^4/μl）. Before cell injection all patients were treated for sear tissue in the section of spinal cord injury. The injection points were selected at the sites of posterior horn of the spinal cord 0.5cm proximal and distal to the spinal cord injury area. The insertion depth of the needle was about 3ram, and the volume of injected cells about 40μl. After transplantation, conventional treatment was given to all patients. The changes in paraplegic plane and muscle strength were evaluated every three months; data of self-evaluations were collected; the changes in neural function were evaluated by ASIA scoring. Difference of the scorings of ASIA were analyzed by single factor analysis .Results The mean follow-up time was 3.2 years, ranging from 0.5 to 5.2 years. Postoperatively, 9 out of the 10 patients with total paralysis showed descending of paraplegic plane for one to two spinal segments, but no change in motion ability was observed. Among the 13 patients with sensory tetraplegia, 11 and 2 showed descending of paraplegic plane for two and three spinal segments respectively. Notably 1 of the 2 patients displayed an improvement of flexor function and the emergence of thumb long extensor dorsiflexion movement （muscle strength： 2 degrees）. No obvious complications were found in all patients during follow-up. No mass or cavity formation was detected by MRI at the sites of transplantation. The self-evaluations of the patients for OECT were as follow： 2 eases were excellent, 9 good, 12 poor, and 1 bad. The rate of good response was 46 %. The pinprick score and light tough score of the patients were 41.73 ± 27.07 and 40.18 ± 29.15 respectively on admission. They increased to 48.18 ± 24.89 and 47.09 ± 27.03 respectively after transplantation and were 53.64 a： 26.08 and 47.09 ± 27.03 respectively at the last follow-up （F = 7.71, F = 4.56, P = 0.00, P = 0.02）. Conclusions The transplantation of olfactory ensheathing cells derived from embryonic olfactory bulb is safe for spinal cord injury. The clinical symptoms of patients receiving transplantation were improved, but this improvement was limited. Further studies are needed.
出处
《中华细胞与干细胞杂志（电子版）》
2012年第3期30-34,共5页
Chinese Journal of Cell and Stem Cell（Electronic Edition）
关键词
脊髓损伤
移植
胚胎
嗅鞘细胞
疗效评价
Spinal cord injury： Transplantation
Fetal
Olfactory ensheathing cells
Long-termed follow-up
