异体嗜铬细胞蛛网膜下腔移植治疗晚期癌痛病人的可行性  

Feasibility of subarachnoid chromaffin cell allograft for terminal cancer pain

作　　者：傅志俭[1] 宋文阁[2] 毕好生[1] 赵松云[2] 马玲[2] 杨茂元[1] 

机构地区：[1]同济医科大学附属同济医院麻醉学教研室,武汉市430030 [2]山东省立医院疼痛科

出　　处：《中华麻醉学杂志》2000年第12期709-712,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科研基金! ( 3 95 70 684) ;卫生部自然科研基金!( 98 1 12 9)

摘　　要：目的　评价异体嗜铬细胞蛛网膜下腔移植治疗晚期癌痛的镇痛效果和安全性。方法　选择经常规方法治疗仍不能缓解的晚期癌痛病人 10例 ,随机分为两组。试验组 (n =4)经蛛网膜下腔注入体外培养 3d的细胞悬液 2ml;对照组 (n =6 )注入同体积细胞培养液。移植后继续应用阿片制剂。移植前、后观察病人的疼痛程度 (VAS法 )和阿片制剂日摄量 ,分别采用高效液相色谱法及放射免疫技术测定脑脊液儿茶酚胺和脑啡肽的浓度以及采用免疫技术测定T淋巴细胞亚群及血清抗体和补体水平。结果　与移植前比较 ,两组病人的VAS值均显著性降低 (P <0 0 5或 0 0 1) ;试验组阿片制剂日摄量移植后有显著性减少 (P <0 0 5或 0 0 1) ,对照组无明显变化 ;两组病人脑脊液儿茶酚胺浓度均显著性升高 (P <0 0 1) ,脑啡肽浓度均显著性降低 (P <0 0 1) ;两组病人的血清抗体、补体及T淋巴细胞亚群的变化幅度均在正常值范围之内。结论　异体嗜铬细胞移植对癌痛病人具有肯定的镇痛效果 ,且在应用免疫抑制剂情况下 ,免疫功能稳定 ,是一种安全有效的治疗方法。Objective To evaluate the analgesic effect and safety of subarachnoid chromaffin cell allograft for terminal cancer pain Methods Ten patients with intractable cancer pain despite traditional treatments were randomly divided into two groups In test group(n=4), 2ml of the suspension chromaffin cells cultured in vitro for 3 days was injected into the subarachnoid space through lumber puncture The same amount of cell free culture solution was injected intrathecally in control group(n=6) Opioids were administered continuously after transplantation The intensity of pain was assessed by VAS, the dose of opioids taken was recored,and the catecholamine and enkephalin concentrations in cerebrospinal fluid and immune function were measured before and after transplantation Results The VAS scores declined markedly in both groups after transplantation (P<0 05 or 0 01) The dose of the opioids taken by the patients in test group gradually decreased following transplantation but remained unchanged in control group The catecholamine level in cerebrospinal fluid increased significantly, but the enkephalin level greatly decreased in both groups (P<0 01) The changes in serum levels of antibodys,complements and T lymphocytes were all within the normal range in both groups Conclusions Subarachnoid chromaffin cell allograft can produce a definite analgesia for terminal cancer pain and the immune function of patients remains stable despite immunosuppressant treatment, indicating that this therapeutic method is effective and safe for patients with terminal cancer pain

关 键 词：晚期癌痛 嗜铬细胞蛛网膜下腔移植 异体移植 

分 类 号：R730.5[医药卫生—肿瘤] R441.1[医药卫生—临床医学]