脐带间充质干细胞移植治疗急性脊髓损伤的临床价值

Clinical value of umbilical cord mesenchymal stem cells transplantation in the treatment of acute spinal cord injury

中文关键词:  急性脊髓损伤  脐带间充质干细胞  移植  功能恢复

英文关键词:Acute spinal cord injury  Umbilical cord mesenchymal stem cells  Transplantation  Functional recovery

中文摘要:

  【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 measure Ⅲ，SCIM-Ⅲ）评分、T细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+）、免疫球蛋白（IgG、IgA、IgM），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+、IgG、IgA、IgM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+、IgG、IgA、IgM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。

英文摘要:

  【Abstract】 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 anti-inflammatory, 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 was 18.0% 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.