胚胎嗅鞘细胞再移植治疗晚期脊髓损伤1例  

Retransplantation of fetal olfactory ensheathing cells for chronic spinal cord injury in 1 case

作　　者：陈琳[1,2,3] 黄红云[1,2,3] 江昭[1,2,3] 张峰 郗海涛[1,2,3] 张健[1,2,3] 刘彦铖[1,2,3] 王洪美[1,2,3] 

机构地区：[1]北京市虹天济神经科学研究院,北京市100041 [2]北京市西山医院暨北京康复中心神经外科,北京市100041 [3]北京市石景山区西山神经再生和功能重建研究所,北京市100041

出　　处：《中国组织工程研究与临床康复》2007年第33期6690-6692,共3页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:对晚期脊髓损伤患者开展嗅鞘细胞再移植治疗,探讨其对神经功能的继续改善效果。方法:①患者男性,27岁,哈萨克斯坦籍,2001年9月20日遭霰弹枪击急诊手术后,双下肢不能运动及感觉消失,尿便失禁,右下肢阵发性钝痛。诊断为陈旧性完全性脊髓损伤(T12),美国脊髓损伤协会标准脊髓功能分级为A级。2002年9月30日第1次行脊髓胚胎嗅鞘细胞移植术,2007年2月5日行第2次脊髓胚胎嗅鞘细胞移植术。治疗方案患者知情同意。②取4个月流产胚胎(孕妇及其家属均知情同意)的嗅球,消化成单个嗅鞘细胞后培养2周,细胞浓度约2×1010L-1。于患者相应脊髓损伤上端(平T11椎体)做1个锁孔,直径约3cm,在脊髓损伤部位与正常脊髓交界处沿中线于无血管区,分两点用4.5号细针共注入100μL(第1次手术)、50μL(第2次手术)嗅鞘细胞悬液,细胞数均为1×106个。第2次移植术前进行供、受体细胞HLA配型,术后口服FK506胶囊2mg,2次/d,共42d。结果:①第1次术后3个月,排尿能控制6h,双足运动功能改善,性功能改善,阴茎勃起功能改善,疼痛减轻。②第2次术后10d,双下肢双足皮肤泌汗功能改善,右下肢疼痛减轻,腹部皮肤感觉稍有好转,针刺觉左侧由术前T10皮节消失好转至T10减退。较第2次移植前椎旁躯体感觉诱发电位有所改善,双侧椎旁电位从T10下降到T12。结论:胚胎嗅鞘细胞二次移植能继续改善晚期脊髓损伤患者的神经功能。但移植的细胞数量、容积、注射点位置等需深入探讨。AIM： To explore the efficacy of olfactory ensheathing cell （OEC） on neural function after intraspinal retrensplantation on the treatment of chronic spinal cord injury （SCI）, METHODS： ①One 27-year-old man of Kazakstan with chronic complete spinal cord injury at thoracic vertebrae 12 （T12）, who had suffered from paraplegia, urinary and fecal incontinence, and severe pain in right lower limb following a emergency operation due to a gunshot wound on September 20m, 2001, was selected as subject. It was A-level injury according to the standard of America Spinal Injury Association. The subject was treated with two OEC intraspinal transplantations in September 30m, 2002 and February 5m, 2007, respectively, Therapeutic scheme was known by the patient. ②lfactory bulb of 4-month aborted fetus was obtained with the agreement of pregnant women and their family members and trypsinized to single OECs, and then cultured for 2 weeks with concentration of 2x10^10 L^-1. A keyhole with the diameter of 3 cm was made on T11. 100 μL（the first operation） and 50 μL （the second operation） OEC suSpension were injected into avascular area along median line of juncture between injured spinal cord and normal spinal cord with No. 4.5 fine needle （lx10^6 each time）, respectively, Donor and receptor HLA zygosity was done before the second transplantation. The patient took orally FK506 capsule 2 mg, twice a day for 42 days after operation, RESULTS： ①The patient was able to control his urination well for 6 hours at month 3 after the first transplantation. His both ankles moved freely and his sexual function involved penis erection ameliorated, The pain relieved. ②10 days after the second transplantation, the sweating in his both feet increased, the pain in his lower limb reduced, skin of abdomen was better and the sensation to pin prick improved from absent to decreased at the dermatome of T10 he findings of paraspinal somatosensory evoked potentials （PSSEPs） showed that the sensory level declined from T

关 键 词：脊髓损伤 脊髓移植 再手术 嗅鞘细胞 

分 类 号：R394.2[医药卫生—医学遗传学]