晚期脊髓损伤患者嗅鞘细胞移植术对交感神经皮肤反应和神经功能的影响  

Effect of OEC transplantation on sympathetic skin response and nerve function of patients with late spinal cord injury

作　　者：郑遵成 郑华 匡乃峰 魏树刚 魏开斌 程宗[3] 

机构地区：[1]泰安中心医院骨科,271000 [2]泰安荣军医院脊柱脊髓科 [3]泰山医学院统计学教研室

出　　处：《中华细胞与干细胞杂志（电子版）》2012年第3期14-18,共5页Chinese Journal of Cell and Stem Cell（Electronic Edition）

摘　　要：目的 探讨嗅鞘细胞移植术对脊髓损伤患者术对交感神经皮肤反应（SSR）及神经功能的影响.方法 （1）选择晚期脊髓损伤患者43 例（男33 例,女10 例,完全性脊髓损伤17 例,不完全性脊髓损伤26 例）;（2）取胚胎嗅球,分离培养,制成嗅鞘单细胞悬液,其细胞浓度1×10^10 个/ L ;（3）全麻下借助手术显微镜行脊髓损伤区域多靶点移植,嗅鞘细胞数（1- 4）×10^6 个/ 视野;（4）在相同的条件下,术前1 d 和术后3 周至2 个月,应用肌电图诱发电位仪诱发SSR 的波幅、潜伏期,以美国脊柱损伤协会（ASIA）运动感觉评分进行评估.手术前后的运动总分、痛觉总分和触觉总分及SSR 的波幅、潜伏期的比较采用配对t 检验.结果 43 例患者移植术前后运动感觉ASIA 评分中,痛觉总分移植术前（60.609 ± 18.297）分,移植术后（69.837± 17.871）分,差异有统计学意义（t = 3.164 ;P = 0.002）;43 例患者术前SSR 引出32 例,术后SSR 引出34 例,较术前增加2 例;术后SSR 潜伏期及波幅优于术前,移植前后经皮肤反应的波幅分别为（1.346 ± 0.563）μV、（1.772 ± 0.645）μV（t = -6.330,P = 0.000）、潜伏期分别为（2.826 ± 0.328）ms、（2.410 ± 0.266）ms,总分差异比较有统计学意义（t = 11.840,P = 0.000）.结论 嗅鞘细胞移植术改善了脊髓损伤患者的运动、感觉和植物神经功能;SSR 和ASIA 两者结合更能准确全面地反映细胞移植后脊髓神经功能的变化.Objective To explore the effect of olfactory ensheathing cell transplantation on sympathetic skin response （SSR） and nerve function of patients with late spinal cord injury. Methods （1）Forty-three patients who were diagnosed with late SCI were enrolled （33 males, 10 females, 17 complete cases, 26 incomplete cases）;（2） Cells from embryonic olfactory bulb were isolated, cultured and made into single cell suspension （the cell concentration was about 1 ×10^10 L-l）; （3） About （1 - 4）×10^6 olfactory ensheathing cells were transplanted to multiple points in spinal cord injury area under surgical microscope after general anesthesia, （4）The sympathetic skin reaction （SSR） amplitude, lantencies and ASIA scores were evaluated one day before and 3 weeks to 2 months after surgery under the same conditions. Results In ASIA scores, the total pain score was （60.609 ± 18.297）before transplantation and （69.837：t： 17.871） after transplantation. The difference was significant （t = 3.164, P = 0.002）. Of all the 43 patients, 32 had SSR before surgery and 34 had SSR after surgery. SSR latency and amplitude measured after surgery was improved after transplantation. The spinal cord motor and sensory function after surgery also improved significantly, as demonstrated by higher ASIA scores. The amplitudes of skin reaction before and after transplantation were 1.346 ± 0.563 and 1.772 ± 0.645 respectively （t = -6.330, P = 0.000）. The latences were 2.826 ± 0.328 and 2.410 ± 0.266 respectively（t = 11.840, P = 0.000）. Conclusions Olfactory ensheathing cell transplantation improved the motor, sensory and autonomic function of patients with spinal cord injury; ASIA combined with SSR is a better indicator for nerve function after OEC transplantation.

关 键 词：嗅鞘细胞移植 脊髓损伤 交感神经皮肤反应 ASIA评分 

分 类 号：R651.2[医药卫生—外科学]