胚胎嗅鞘细胞移植治疗肌萎缩侧索硬化症的近期疗效

目的探讨人胚胎嗅鞘细胞（olfactory ensheathing cells，OECs）移植治疗肌萎缩侧索硬化症（amyotrophic lateral sclerosis，ALS）患者的近期安全性和有效性。方法回顾性分析2003年2月～2006年4月，采用OECs移植手术治疗的327例ALS患者的临床资料。男241例，女86例。年龄20～84岁（51．6±11．1岁）。病程4．8个月～13年（2．9±2．0年）。根据细胞植入部位分为3组：A组29例，细胞植入脊髓内；B组（6例），细胞分别植入脊髓及双额叶放射冠；c组292例，细胞植入双额叶放射冠。脊髓移植方法，病变处分两点共注入50μlOECs悬液，细胞数约1×10^5个。脑部移植方法，双侧大脑放射冠处各注射50μlOECs悬液，细胞数约2×10^6个。结果随访4周，比较术前和随访肌萎缩侧索硬化症功能量表分数变化。A组17．2±8．6增至20．1±9．7（P〈o．05），B组24．2±6．8增至25．7±6．6（P〉0．05），C组20．3±8．6增至22．0±9．4（P〈0．001），3组间改善程度差异无统计学意义（P〉0．05）。4周神经功能总改善252例（77．1％）。术后4周行肌电图检查的患者261例（79．8％）显示术后自发电位减少或消失，收缩时肌电波幅较术前明显降低，电位密度明显增加。16例（4．9％）术后出现不良反应，包括头痛、短期发热、癫痫大发作、中枢神经系统感染、肺炎、呼吸衰竭、泌尿系感染、心力衰竭及肺栓塞，其中4例（1．2％）死亡。结论OECs移植术后4周能阻止或逆转ALS的病情恶化。

Short-term Outcome of Olfactory Ensheathing Cells Transplantation for Treatment of Amyotrophic Lateral Sclerosis

OBJECTIVE: To determine whether transplanting olfactory ensheathing cells (OECs) is effective in controlling or reversing the deterioration caused by amyotrophic lateral sclerosis (ALS). METHODS: Between February 2003 and April 2006, 327 patients (241 males and 86 females) with probable or definite ALS (diagnosed according to the El Escorial criteria) received the OECs transplantation. Their ages ranged from 20 to 84 years (51.6 +/- 11.1 years). The duration of symptoms before surgical treatment was 4.8 months to 13 years (2.9 +/- 2.0 years). OECs were cultured and injected into pathological regions of the spinal cord and/or bilateral corona radiata of the brain; the patients were divided into three groups, group A (cord only, n = 29), group B (cord and brain, n = 6), and group C (brain only, n = 292) based on the transplant sites. RESULTS: The patient's neurological function was assessed both before and at 4 weeks after transplantation by using the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) of the ALS CNTF Treatment Study (ACLS). The scores were increased from 17.2 +/- 8.6 pre-operation to 20.1 +/- 9.7 post-operation in group A (P < 0.05), from 24.2 +/- 6.8 to 25.7 +/- 6.6 (P > 0.05) in group B, and from 20.3 +/- 8.6 to 22.0 +/- 9.4 (P < 0.001) in group C. There were no significant difference in increased ALSFRS scores among the three groups (P > 0.05). The total improvement rate of neurological function was 77.1% (252/327). The result of electromyographic examination showed that spontaneous potential diminished and/or disappeared, the amplitude of the motor unit action potential decreased remarkably and the numbers of motor unit action potential greatly increased in 261 cases (79.8%). Sixteen patients (4.9%) experienced the various complications including headache, short-term fever, seizure attack, central nerve system infection, pneumonia, respiratory failure, urinary tract infection, heart failure, and possible pulmonary embolism; of them, there were 4 deaths (1.2%). CONCLUSION: These preliminary results suggest that the OECs transplantation is effective in controlling or reversing the physiological deterioration caused by ALS.