嗅鞘细胞移植治疗Friedreich共济失调疗效及机制探讨  

Olfactory ensheathing cell therapy for treating Friedreich ataxia

作　　者：郗海涛[1,2] 陈琳 黄红云[1,2] 张峰 刘彦铖[1,2] 陈娣 王庆苗[1,2] 

机构地区：[1]北京市虹天济神经科学研究院 [2]北京康复中心神经修复中心,100144

出　　处：《中华临床医师杂志（电子版）》2011年第19期5590-5593,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨胚胎嗅鞘细胞移植治疗Friedreich共济失调的疗效及机制。方法选择2005年8月至2009年5月收治的确诊Friedreich共济失调患者11例,采用胚胎嗅鞘细胞脊髓内或脑内移植治疗。其中4例在全麻下行脊髓内细胞移植手术,7例局麻下行脑内细胞移植手术。术前和术后2～4周采用世界神经病联合会国际合作共济失调量表(ICARS)评价其治疗结果。结果 2～4周后11例患者ICARS由术前50.73±21.80降至45.27±23.99(P=0.004)。脊髓内移植和脑内移植两组患者评分改善无差异(P=0.104)。改善主要表现在行走能力、步态、站立平衡方面。术后无发热、头痛、头晕、恶心及呕吐等神经系统并发症发生。其中8例患者进行半年以上的远期随访,4例平衡及行走功能仍有改善,MRI复查显示脊髓或脑无明显变化,移植部位及其周围未发现新生肿瘤、出血、水肿、囊性变形成、神经结构破坏、感染等病理改变。4例患者病情平稳。结论嗅鞘细胞移植治疗Friedreich共济失调能够使神经功能得到部分改善,生活质量相对提高。脑内移植和脊髓内移植结果无明显差异。验证脑内存在神经网络修复关键点,细胞移植到此部位,可能对整个大脑、小脑、脊髓神经网络功能产生广泛双向调节。Objective To explore the therapeutic effect and probable mechanism of olfactory ensheathing cell (OEC) transplantation for Friedreich's ataxia patients.Methods Eleven patients with Friedreich's ataxia were treated by OEC transplantation from August 2005 to May 2009.OECs were implanted into the spinal cord involved region in 4 patients and the corona radiata of the frontal lobe (key point for neural network restoration,KPNNR) bilaterally in 7 patients.The neurological function was assessed before and 2 to 4 weeks after operation though International Cooperative Ataxia Rating Scale (ICARS) by World Federation of Neurology.Results ICARS score decreased from pre-operative 50.73±21.80 points to post-operative 45.27±23.99(P=0.004).There were no significant difference in two groups which transplanted into spinal cord and brain (P=0.104).All patients achieved neurological function amelioration to different degrees,which including walking ability,gaits and standing.Of them,8 patients were followed up for over six months.Balance and walking ability keep improving in 4 patients.The follow-up MRI did not reveal any development of tumor,hemorrhage,edema,cyst formation,infection or disruption of the neural structure in and surrounding these transplant sites.Four patients keep stable.No complications occurred within the period of 2 to 4 weeks after surgery and long term follow-up.Conclusions OEC transplantation appears to be benefit for patient with Friedreich's ataxia and no remarkable difference between two groups (intracranial and intraspinal).KPNNR may be the site which can dual-directionally regulate the neural signals among neural network of cerebra,cerebellum and spinal cord followed cell transplant.

关 键 词：共济失调 移植 脊髓 脑 神经网络修复关键点 嗅鞘细胞 

分 类 号：R651.2[医药卫生—外科学]