自体骨髓间充质干细胞联合周围神经移植治疗脊髓损伤  

Autologous bone marrow mesenchymal stem cells in combination with peripheral nerve transplantation for treating spinal cord injury

作　　者：李志营[1] 步星耀[1] 张圣旭[1] 梁庆华[1] 李太平[1] 陈书连[2] 李六一[3] 赵耀武[4] 翟亚平[5] 张永福[1] 

机构地区：[1]河南省人民医院神经外科,河南省郑州市450003 [2]河南省人民医院骨科,河南省郑州市450003 [3]河南省人民医院生物研究所,河南省郑州市450003 [4]河南省人民医院肌电图室,河南省郑州市450003 [5]河南省人民医院血液研究所,河南省郑州市450003

出　　处：《中国组织工程研究与临床康复》2008年第16期3041-3044,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：河南省科技攻关项目(0524420054);河南省医学科技攻关计划资助项目~~

摘　　要：目的：研究发现,应用骨髓间充质干细胞联合周围神经移植治疗脊髓损伤有协同作用。实验拟验证自体骨髓间质干细胞联合周围神经移植治疗脊髓损伤的临床疗效,为脊髓损伤的治疗开辟新途径。方法：选择2003/2004河南省人民医院神经外科干细胞移植治疗中心收治的78例完全性脊髓损伤患者。男52例,女26例,年龄18-52岁。其中颈髓损伤12例,胸髓损伤46例,腰骶髓损伤20例,损伤1周至60个月。患者对治疗知情同意,并要求采用该方法治疗。无菌条件下,自患者髂前上棘及髂后上棘通过骨髓穿刺抽取骨髓,分离、纯化、培养骨髓间充质干细胞。选取患者自体腓肠神经作为周围神经移植供体,将自身腓肠神经应用显微外科方法去除外膜、束膜,并剪神经,使神经组织的质地、外观类似于马尾组织,将其排列呈多条状、纵行植入已切开的脊髓处或原囊肿腔内,然后用分离纯化的骨髓间充质干细胞移植焊接移植的神经,对患者行自体骨髓间充质干细胞联合周围神经移植治疗,术后给予神经生长因子等药物应用,疗程为1个月,以促进损伤神经的修复。实验评估：通过电话随访和患者定时回医院复查的方式,术后每3个月随访1次,随访1年。术前、术后和随访按国际截瘫医学会评分标准ASIA评分标准评分,评分的增高表示患者的运动和感觉的功能的恢复。同时进行神经电生理、影像学等方面对比分析。结果：78例患者中除1例严重复合伤患者出现并发症,经积极治疗无效死亡,其余患者术后均顺利出院,原有症状改善情况,未出现明显不良毒副反应。患者术后ASIA评分的平均数较术前提高。37例出现运动、感觉、影像学、神经电生理方面的不同改善,25例出现不同程度的运动,感觉、神经电生理方面的改善,9例出现神经电生理方面的改善,6例无变化,1例死亡;在随后的1年随访中,除2例失访外,�AIM： There are synergistic effects of bone marrow mesenchymal stem cells （BMSCs） combined with peripheral nerve transplantation for spinal cord injury （SCI）. This article confirmed the therapeutic effect of BMSCs combining peripheral nerve transplantation on SCI. A new therapeutic method for SCI was authenticated. METHODS： Totally 78 patients with complete SCI aged 18-52 years （52 males and 26 females） were enrolled at the Stem Cell Transplantation Center of Department of Neurosurgery of Henan People＇s Hospital from 2003 to 2004. There were 12 patients with cervical cord injury, 46 patients with thoracic cord injury and 20 patients with lumbar sacral cord injury （injured for 1 week to 60 months）. All patients singed informed consents. Bone marrow was sterilely collected from the anterior superior iliac spine and posterior superior iliac spine by bone marrow aspiration. BMSCs were harvested, purified and cultured. Autologous sural nerve was obtained from patients as donor for peripheral nerve transplantation. Adventitial coat of autologous sural nerve was removed, clustered and cut into cauda equina-like tissues, which were arranged stick-shape and longitudinally transplanted into the spinal cord or cystis. Patients received autologous BMSCs combined with peripheral nerve transplantation. These patients were treated with nerve growth factor after transplantation for one month to improve the restoration of injured nerve. Post-operative follow-up was performed by telephone or going back to hospital every three months, totally for 1 year. Preoperative and postoperative evaluation and follow-up were conducted according to International Medical Society of Paraplegia standards, American Spinal Injury Association （ASIA） scores, and the higher score represented the restoration of exercises and sensory function. Simultaneously, controlled analysis was done in imageology, and neural-electrophysiology. RESULTS： All of the 78 patients were smoothly discharged except for l patient with serious c

关 键 词：移植 骨髓间充质干细胞 周围神经 脊髓损伤 

分 类 号：R394.2[医药卫生—医学遗传学]