晚期脊髓损伤患者胚胎嗅鞘细胞移植后的电生理评价  

Electrophysiological evaluation in patients with chronic spinal cord injury after olfactory ensheathing cell transplantation

作　　者：陈琳[1] 黄红云[1] 王援朝[1] 张峰[1] 郗海涛[1] 张健[1] 刘彦铖[1] 

机构地区：[1]北京市虹天济神经科学研究院

出　　处：《中国组织工程研究与临床康复》2007年第24期4738-4741,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:采用客观的电生理检查手段评价胚胎嗅鞘细胞移植治疗晚期脊髓损伤的有效性。方法:①对象:选择2003-02/2005-01北京市西山医院暨北京康复中心神经外科收治的接受人胚胎嗅鞘细胞移植治疗的晚期完全性脊髓损伤患者199例,男164例,女35例,平均年龄(34.7±11.3)岁,平均病程(4.7±5.5)年;受伤节段:颈段99例,胸段89例,胸腰段11例;受伤原因:车祸、摔伤、医源性损伤、机器挤压伤等。4个月流产胚胎由北京市虹天济神经科学研究院协作医院提供,产妇及其家属均签署知情同意书,实验经医院医学伦理委员会批准。②方法:取人胚胎嗅球,消化成单个嗅鞘细胞后培养2周。199例晚期完全性脊髓损伤患者均接受人胚胎嗅鞘细胞移植治疗,在全麻下行脊髓损伤节段后方入路,切开硬膜,显露出病变脊髓。分上下两点各注入50μL嗅鞘细胞悬液,细胞数共约1×106个。术后给予止血、抗感染等处理,未使用任何免疫抑制剂。③评估:移植前后分别采用肌电/诱发电位仪检查肌电图和椎旁躯体感觉诱发电位,每例患者检查2次,时间一致,且由同一医生操作。肌电图即检查患者大力收缩时的肌肉情况,以观察运动单位电位的数量、波幅及持续放电能力。椎旁躯体感觉诱发电位是于中线旁开2cm处两侧同时给予刺激,刺激强度以引起可见的肌肉抽动为准,在头皮上记录电位。方波刺激频率3Hz,强度20～40mA,时限0.2ms,观察感觉平面下降情况。结果:199例晚期完全性脊髓损伤患者均进入结果分析。①术后肌电图检查:93例(46.7%)显示部分受累肌肉大力收缩时募集波型改善,运动单位电位数量增加;105例(52.8%)无变化,1例(0.5%)比术前差。②椎旁躯体感觉诱发电位检查:90例(45.2%)显示感觉平面下降,其中左侧平均下降(1.9±1.2)个节段,右侧平均下降(2.0±1.2)个节段;107例(53.8%)无变化,2例(1.0%)双侧感觉平面上升。结论:对�AIM： To study the therapeutic effect of olfactory ensheathing cells （OECs） transplantation for chronic spinal cord injured （SCI） patients by using electrophysiological examination. METHODS：①199 chronic spinal cord injured patients were enrolled at the Department of Neurosurgery, Beijing Xishan Hospital ＆ Beijing Rehabilitation Center between February 2003 and January 2005. Of them, 164 were male and 35 were female with an average age of （34.7±11.3） years. The procedures of OECs implant were performed on patients with SCI with a mean of （4.7±5.5） years. The damaged cord was located at cervical segments in 99 cases, thoracic segments in 89 cases, and thoracolumbar segments in 11 cases. The etiology of SCI included motor vehicle accidents, falls, iatrogenic injury, machine extrusion and so on. Aborted fetuses aged 4 months were gathered at the cooperative hospitals of Beijing Hongtianji Neuroscience Academy after the donation consent papers were signed by parturient and their family members. The Clinical Study Ethics Committees of the Xishan Hospital approved the clinical study protocols and procedures. ②Aborted fetal olfactory bulb was obtained and trypsinized to single OECs, which were cultured for 2 weeks. 199 chronic complete SCI patients received human OECs transplantation. Posterior approach at SCI segments was done under general anesthesia. Dura was cut to expose injured spinal cord. The fetal OECs of 50 μL containing 1×10^6 cells were transplanted by injection into the patients＇ spinal cords directly above and below the margin of injury. Hemostasis and anti-infection were given after operation. No immunosuppressants were administered during the course of treatment. ③Electromyography （EMG） and paraspinal somatosensory evoked potentials （PSSEP） examination with Keypoint-4 electromyograph of evoked potential were performed before and after fetal OECs transplantation at the same time by the same doctor in all patients. The amount of motor unit potential （MUP）, wave a

关 键 词：脊髓损伤 肌电图 躯体感觉诱发电位 嗅鞘细胞移植 

分 类 号：R651.21[医药卫生—外科学]