嗅鞘细胞再移植治疗肌萎缩侧索硬化症1例  

Retransplantation of fetal olfactory ensheathing cells for amyotrophic lateral sclerosis in 1 case

作　　者：陈琳[1,2,3] 黄红云[1,2,3] 张健[1,2,3] 江昭 张峰[1,2,3] 刘彦铖[1,2,3] 郗海涛[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37期7465-7467,共3页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:探讨嗅鞘细胞再移植对肌萎缩侧索硬化症患者的治疗价值。方法:①患者资料:选择2005-05北京市虹天济神经科学研究院收治的肌萎缩侧索硬化症患者1例,男性白种人,42岁,西班牙籍,四肢无力伴肌萎缩进行性加重2年,分别于2005-05-27日和2006-10-11日给予嗅鞘细胞脑内移植。治疗方案患者知情同意。②移植方法: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。第2次移植术前进行供、受体细胞HLA配型。根据两次术前MRI图片,选取双额放射冠锥体束走行部位为注射细胞靶点,局麻下采用立体定向技术注射胚嗅鞘细胞100万个/侧。术后口服他克莫司胶囊1mg,2次/d,共42d。③功能评估:电子邮件随访5个月,采用国际统一的肌萎缩侧索硬化功能评分标准进行延髓和呼吸功能、上肢功能、下肢功能、其他功能评定,功能从完全丧失至正常为0～4分,总分40分。结果:①患者在围手术期及随访期内均未发现任何不良事件及副反应。②术前5个月内,肌萎缩侧索硬化功能评分由33分迅速降至17分。③第1次术后2周检查,患者肢体运动功能改善,双上肢抬举好转,书写较术前清晰,站立行走时平衡能力改善,翻身及穿衣好转,肌萎缩侧索硬化功能评分由17分增加至24分。出院后半年患者病情保持稳定。2005-10,双下肢力量较前稍下降,且坐位控制平衡能力下降。2005-12患者腕部及手部无力开始缓慢加重。至术后17个月肌萎缩侧索硬化功能评分为18分。④第2次术后1周检查,双上肢、腹部和双下肢力量有所增加,但肌萎缩侧索硬化功能评分仍为18分。再次出院后5个月随访,分数增加至20分。结论:嗅鞘细胞移植能改善肌萎缩侧索硬化症患者神经功能障碍的症状,再次治疗仍然有效。AIM： To explore the therapeutic value of olfactory ensheathing cell （OEC） intracranial retransplantation in the treatment of amyotrophic lateral sclerosis （ALS）. METHODS： ①Patients＇ data： One 42-year-old male white Spain patient with ALS, who had suffered from gradually progressive weakness and atrophy in his limbs for 2 years and treated in Beijing Hongtianji Neuroscience Academy in May 2005, was selected as subject. The subject was treated with two OEC transplantations on May 27th, 2005 and October 11% 2006, respectively. He knew and agreed the therapeutic regimen.②Transplanted method： Fetal olfactory bulb was obtained （Pregnant women and their family members knew and agreed） and trypsinized to single OECs, which were cultured for 2 weeks with the concentration of 2×10^10 L^-1. HLA zygosity of receptor and donor was performed before the second transplantation. According to MRI result, pyramidal tract of corona radiate of the frontal lobe bilaterally was used as injection target. 1 000 000 OEC, s were injected by stereotactic technique under local anesthesia. 1 mg tacrolimus capsule was taken orally after operation, twice a day for 42 days. ③Functional evaluation： E-mail follow-up was conducted for 5 months. Bulbus medullae and respiratory function, upper limb function, lower limb function, and other functions were assessed according to the Amyotrophic Lateral Sclerosis Functional Rating Scale （ALSFRS）. Score on complete loss of the functions to normal functions ranged from 0-4 points, totally 40 points. RESULTS： ①There was no complication or side effect during perioperative and follow-up period. ②The patient＇s ALSFRS score decreased rapidly from 33 to 17 points 5 months before the first transplantation. ③The power of his four limbs had been becoming better which led to the improvements of handwriting, the balance, and turning in bed and adjusting bed clothes. His ALSFRS score increased from 17 to 24 points within 2 weeks after the first operation. The patient＇s neu

关 键 词：肌萎缩侧索硬化症 脑内移植 再手术 嗅鞘细胞 

分 类 号：R457.7[医药卫生—治疗学]