脐带间充质干细胞移植治疗急性脊髓损伤的临床价值
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摘要
目的:探讨脐带间充质干细胞移植(umbilical cord mesenchymal stem cells,UC-MSC)治疗急性脊髓损伤(acute spinal cord injury,ASCI)的临床价值。方法:选择2017年1月～2018年1月我院收治的50例ASCI患者作为研究组,同时以同期的50例ASCI患者作为对照组。所有患者在受伤后72h内进行减压内固定术,对照组患者给予抗炎、脱水、抗感染及神经营养等常规治疗,研究组患者在对照组的基础上采用腰穿鞘内注射脐带间充质干细胞。比较治疗前及治疗后3、6、12个月两组的功能指标恢复情况,包括ASIA分级与评分、Botsford及脊髓损伤独立量表Ⅲ(spinal cord independence measureⅢ,SCIM-Ⅲ)评分、T细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)、免疫球蛋白(Ig G、Ig A、Ig M),观察不良反应(头痛、发热、胃肠功能紊乱、尿路感染等)发生情况。结果:治疗后3、6、12个月,两组的ASIA等级改善率、ASIA运动评分、ASIA感觉评分、Botsford评分及SCIM-Ⅲ评分均呈不断增高趋势(P<0.05),CD3+、CD4+、CD4+/CD8+水平呈不断降低趋势(P<0.05),CD8+、Ig G、Ig A、Ig M水平均无明显变化(P>0.05),研究组的ASIA等级改善率、ASIA运动评分、ASI感觉评分、Botsford评分及SCIM-Ⅲ评分均明显高于对照组(P<0.05),两组之间的CD3+、CD4+、CD8+、CD4+/CD8+、Ig G、Ig A、Ig M水平比较差异无统计学意义(P>0.05);研究组与对照组的不良反应发生率分别为18.0%、14.0%,两组间比较差异无统计学意义(P>0.05)。结论:间充质干细胞能够明显促进ASCI患者的神经功能恢复,不影响体液免疫且不增加不良反应发生率。
Objectives: To discuss the clinical value of umbilical cord mesenchymal stem cells(UC-MSC)transplantation in the treatment of patients with acute spinal cord injury(ASCI). Methods: 50 ASCI patients were selected as research group in our hospital from January 2017 to January 2018, while 50 ASCI patients were selected as control group in the same period. All the patients were carried out decompression and internal fixation within 72 hours after damaged, the patients were given the conventional treatment of antiinflammatory, dehydration, anti-infection and neurotrophy in control group, the patients were injected umbilical cord mesenchymal stem cells by intravenous infusion combined with lumbar puncture based on conventional treatment in research group. The functional recovery index(ASIA grade and score, Botsford and FIM score), T cell subset(CD3+, CD4+, CD8+, CD4+/CD8+) and immune globulin(IgG, IgA, IgM) were compared between two groups before treatment and in the third, sixth, twelfth month after treatment. And the untoward effect(encephalalgia, fever, gastrointestinal dysfunction, urinary tract infection) was observed. Results: In the third,sixth, twelfth month after treatment, the ASIA grade improvement rate, ASIA movement score, ASIA sensory score, Botsford score and SCIM-Ⅲ score significantly increased continually in two groups(P<0.05), the level of CD3+, CD4+, CD4+/CD8+ significantly decreased continually in two groups(P<0.05), the level of CD8+ and level of IgG, IgA, IgM were not significantly changed in two groups(P>0.05). The ASIA grade improvement rate, ASIA movement score, ASIA sensory score, Botsford score and SCIM-Ⅲ score of research group were higher than those of control group(P<0.05), there was no statistical significance on the level of CD3+, CD4+,CD8+, CD4+/CD8+, IgG, IgA, IgM between two groups(P>0.05). The occurrence rate of untoward effect was18.0% and 14.0% in research group and control group, respectively and there was no statistical significance between the two groups(P>0.05). Conclusions: Umbilical cord mesenchymal stem cells could obviously promote the functional recovery of ASCI patients, and it did not affect the humoral immunity and increase the untoward effect.
Objectives: To discuss the clinical value of umbilical cord mesenchymal stem cells(UC-MSC)transplantation in the treatment of patients with acute spinal cord injury(ASCI). Methods: 50 ASCI patients were selected as research group in our hospital from January 2017 to January 2018, while 50 ASCI patients were selected as control group in the same period. All the patients were carried out decompression and internal fixation within 72 hours after damaged, the patients were given the conventional treatment of antiinflammatory, dehydration, anti-infection and neurotrophy in control group, the patients were injected umbilical cord mesenchymal stem cells by intravenous infusion combined with lumbar puncture based on conventional treatment in research group. The functional recovery index(ASIA grade and score, Botsford and FIM score), T cell subset(CD3+, CD4+, CD8+, CD4+/CD8+) and immune globulin(IgG, IgA, IgM) were compared between two groups before treatment and in the third, sixth, twelfth month after treatment. And the untoward effect(encephalalgia, fever, gastrointestinal dysfunction, urinary tract infection) was observed. Results: In the third,sixth, twelfth month after treatment, the ASIA grade improvement rate, ASIA movement score, ASIA sensory score, Botsford score and SCIM-Ⅲ score significantly increased continually in two groups(P<0.05), the level of CD3+, CD4+, CD4+/CD8+ significantly decreased continually in two groups(P<0.05), the level of CD8+ and level of IgG, IgA, IgM were not significantly changed in two groups(P>0.05). The ASIA grade improvement rate, ASIA movement score, ASIA sensory score, Botsford score and SCIM-Ⅲ score of research group were higher than those of control group(P<0.05), there was no statistical significance on the level of CD3+, CD4+,CD8+, CD4+/CD8+, IgG, IgA, IgM between two groups(P>0.05). The occurrence rate of untoward effect was18.0% and 14.0% in research group and control group, respectively and there was no statistical significance between the two groups(P>0.05). Conclusions: Umbilical cord mesenchymal stem cells could obviously promote the functional recovery of ASCI patients, and it did not affect the humoral immunity and increase the untoward effect.
引文
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14.武玉江,侯英诺,张子檀,等.早期运动训练联合神经干细胞移植对脊髓损伤模型大鼠后肢运动功能的影响[J].中国组织工程研究,2016,20(6):876-882.
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18.杨新明,胡长波,成垚昱.脊髓损伤机制及骨髓间充质干细胞移植治疗机制的研究进展[J].生物骨科材料与临床研究,2016,13(6):68-71.
10.龚九妹,余丽梅.间充质干细胞免疫学特性研究进展[J].生命的化学,2016,36(2):203-207.
20.边培育,雷迎峰,叶传涛,等.间充质干细胞免疫调控作用可塑性的研究进展[J].微生物学免疫学进展,2016,44(6):89-92.
21.曹凯,章涛.间充质干细胞的免疫调节可塑性研究进展[J].医学综述,2018,24(1):34-39.
22.王雨,陈龙菊.脐带间充质干细胞免疫调节功能的研究进展[J].细胞与分子免疫学杂志,2017,33(7):1001-1006.
23.向旭,康健,张萍,等.Toll样受体对间充质干细胞功能调控的研究进展[J].医学综述,2017,23(14):2735-2739.
24.唐超,钟德君.诱导多能干细胞及其移植治疗脊髓损伤的研究进展[J].中国脊柱脊髓杂志,2017,27(4):368-371.
25.郭卫春,周升,熊敏.骨髓间充质干细胞治疗脊髓损伤的研究现状[J].医学综述,2017,23(5):882-886.
2.Christian,A Bowers,Bornali,et al.Methylprednisolone for acute spinal cord injury:an increasingly philosophical debate[J].Neural Regeneration Research,2016,11(6):882-885.
3.张军卫,孙天胜,海涌,等.早期康复干预对脊髓损伤后康复时间的影响[J].中国脊柱脊髓杂志,2015,25(2):115-121.
4.赵鹏飞.甲泼尼龙联合单唾液酸四己糖神经节苷脂治疗急性脊髓损伤的临床研究[J].中国临床药理学杂志,2015,31(9):699-701.
5.刘静,韩冬梅,薛梅,等.脐带间充质干细胞鞘内注射治疗脊髓损伤的长期临床观察[J].组织工程与重建外科,2017,13(6):313-317.
6.张赞,代广辉,刘学彬,等.脐带间充质干细胞移植治疗脊髓损伤疗效观察[J].中华实用诊断与治疗杂志,2015,29(5):478-480.
7.Lu GB,Niu FW,Zhang YC,et al.Methylprednisolone promotes recovery of neurological function after spinal cord injury:association with Wnt/β-catenin signaling pathway activation[J].Neural Regeneration Research,2016,11(11):1816-1823.
8.Li XG,Lin XJ,Du JH,et al.Combination of methylprednisolone and rosiglitazone promotes recovery of neurological function atfer spinal cord injury[J].Neural Regeneration Research,2016,11(10):1678-1684.
9.陈胜,金正帅.不同时期局部移植人脐带间充质干细胞修复脊髓损伤的组织学观察[J].中国组织工程研究,2016,20(45):6714-6719.
10.马娇,张雪梅.骨髓间充质干细胞治疗脊髓损伤的分子机制[J].脑与神经疾病杂志,2016,24(2):117-119.
11.张超.骨髓间充质干细胞移植修复慢性期脊髓损伤的基础研究和转化探索[D].天津医科大学.2016.
12.宋志文,余常麟,丁亚,等.PTEN参与神经干细胞调控及脊髓损伤修复的研究进展[J].中国脊柱脊髓杂志,2016,26(6):555-558.
13.李季,蔡锦芳,邹林,等.骨髓间充质干细胞移植对脊髓损伤模型大鼠Toll样受体4表达的影响[J].中国老年学杂志,2019,39(1):147-151.
14.武玉江,侯英诺,张子檀,等.早期运动训练联合神经干细胞移植对脊髓损伤模型大鼠后肢运动功能的影响[J].中国组织工程研究,2016,20(6):876-882.
15.杨华强,张荣环,杜玲,等.脐带间充质干细胞移植治疗脊髓损伤的临床研究[J].现代生物医学进展,2012,12(3):518-521.
16.刘贵艳,李芳,李小峰.间充质干细胞在自身免疫疾病治疗中的研究进展[J].中华临床医师杂志:电子版,2016,10(18):2772-2775.
17.张超,Chekhonin VP,Bryukhovetskiy AS,等.间质干细胞移植修复脊髓损伤:从基础研究到临床转化[J].中华骨科杂志,2016,36(6):370-377.
18.杨新明,胡长波,成垚昱.脊髓损伤机制及骨髓间充质干细胞移植治疗机制的研究进展[J].生物骨科材料与临床研究,2016,13(6):68-71.
10.龚九妹,余丽梅.间充质干细胞免疫学特性研究进展[J].生命的化学,2016,36(2):203-207.
20.边培育,雷迎峰,叶传涛,等.间充质干细胞免疫调控作用可塑性的研究进展[J].微生物学免疫学进展,2016,44(6):89-92.
21.曹凯,章涛.间充质干细胞的免疫调节可塑性研究进展[J].医学综述,2018,24(1):34-39.
22.王雨,陈龙菊.脐带间充质干细胞免疫调节功能的研究进展[J].细胞与分子免疫学杂志,2017,33(7):1001-1006.
23.向旭,康健,张萍,等.Toll样受体对间充质干细胞功能调控的研究进展[J].医学综述,2017,23(14):2735-2739.
24.唐超,钟德君.诱导多能干细胞及其移植治疗脊髓损伤的研究进展[J].中国脊柱脊髓杂志,2017,27(4):368-371.
25.郭卫春,周升,熊敏.骨髓间充质干细胞治疗脊髓损伤的研究现状[J].医学综述,2017,23(5):882-886.
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