脑卒中患者鞘内神经干细胞注射半年后功能状态评估

背景近年研究证实中枢神经组织有再生能力,但损伤后修复功能较差,很多实验结果不能令人满意.既往的脑移植或脑组织移植最大的生物学障碍是移植物难以在宿主体内生存或发育,移植效果的稳定性及其功能的恢复不肯定.目的探讨鞘内神经干细胞注射治疗脑卒中的方法,观察其疗效及副作用,以评价其安全性及可行性.设计以患者为研究对象,前后对照的验证性研究.单位一所市级医院神经内科和一所大学医院微生物与免疫学教研室.对象2002-11/2003-09安阳市人民医院神经内科住院脑卒中患者26例.其中3例为急性脑出血,其余23例病程3个月～30年,平均(4.2±6.6)年;男20例,女6例;年龄36～72岁,平均(56.3±12.7)岁;脑梗死15例,脑出血11例;合并高血压19例,冠心病2例,糖尿病4例,高脂血症4例.干预3例急性脑出血(出血量35～40mL)患者行微创血肿穿刺术,通过引流管将细胞悬液注射到脑损伤处;其余病例均采用鞘内注射的方法将细胞悬液注入蛛网膜下腔,通过脑脊液循环至大脑表面.术后采用物理治疗、作业治疗及语言治疗进行康复.采用欧洲卒中量表评分标准(Europeanstroke scale,SS)、生活功能评分标准(barthelindex,I)评价其疗效.ESS提高1分以上为有效,无提高或下降为无效.检查患者头颅CT,RI,心电图、胸部X射线片及血液生化学指标.主要观察指标疗效及副反应.结果23例行鞘内注射患者中,9例有效,例无效;移植后ESS评分54.1±21.2,较移植前51.4±21.1提高,差异有显著性意义(t=5.8,P=0.000007 6);移植后BI 41.1±31.3,较移植前36.1±32.1提高,差异有显著性意义(t=7.11,=0.000000 39).3例行微创血肿穿刺术急性脑出血患者均恢复良好,生活可基本自理.4例患者术后24h内出现一过性发热,例患者术后感轻微头痛.结论研究表明神经干细胞移植后患者症状得到不同程度的缓解;且无明显毒副作用.证实神经干细胞移植用于改善脑卒中患者功能状态有效可行.

Functional evaluation of stroke patients 6 months after intrathecal injection of neural stem cells

BACKGROUND: Recent studies have proven the existence of the regeneration of central nervous tissue. But abjective results,such as lacked of neurogenesis after injury,also have been found in many experiments. The greatest difficulty in conventional brain transplantation or brain tissue transplantation has been the survival and development of the graft. Additionally,the stability of therapeutic effects and the rehabilitation of brain functions also need confirmation.OBJECTIVE: To investigate an approach to intrathecal injection of neural stem cells(NSCs) in stroke therapy,and observe therapeutic effects and side effects as well,so as to make the evaluation of the safety and feasibility.DESIGN: A confirmative before-after study based on stroke patients.SETTING: A neurology department in a municipal hospital and a microbiology and immunology department affiliated to a university hospital.PARTICIPANTS: From November 2002 to September 2003,26 stroke inpatients in the Neurology Department of Anyang Municipal People' s Hospital were selected. Of all the c ases,3 were diagnosed as acute cerebral hemorrhage,and the other 23 had been suffering strokes for durations ranging from 3months to 30 years,an average of (4.2 ± 6. 6) years. They were 20 male and 6female between the ages from 36 -72 years old,an average of(56.3 ± 12.7)years old. Fifteen of them were ischemic and 11 were hemorrhagic. Nineteen were associated with hypertension,2 with coronary heart disease,4 with diabetes and 4 associated with hyperlipodemia.INTERVENTIONS: On each of the 3 patients with acute cerebral hemorrhage (hematoma volume,35 - 40 mL),a microinvasive intracerebral hematoma puncture was performed,and then a suspension of NSCs were conducted to the stroke by a drainage tube. For the rest of the patients,suspensions were intrathecally administered into the subarachnoid and then flowed to the cerebral surface through cerebrospinal fluid(CSF) circulation. Afterwards,physical therapy(PT),occupational therapy (OT) and speech therapy(ST) were jointly applied to facilitate the rehabilitation of the stroke patients. Therapeutic effects was calculated according to the European stroke scale(ESS) and the Barthel Index(BI) . If ESS index went beyond or equal to 1 score,the case would be defined as effective; otherwise,it would be defined as not effective. Additionally,CT,MRI,EEG,chest x-ray,and blood biochemical variables were also measured.MAIN OUTCOMEMEASURES: Therapeutic effects and side effects were taken as main outcomemeasurements.RESULTS: Of the 23 patients who ntrathecal administration,19had positive therapeutic effect and 4 did not. Post-transplantation ESS was higher than that of pre-transplantation(54. 1 ±21.2 vs 51.4 ±21.1,t = 5.8,P = 0. 000 007 6),while post-transplantation BI also increased significantly as compared with that of pre-transplantation(41.1 ± 31.3 vs 36. 1 ± 32. 1,vasive intracerebral hematoma puncture had successful rehabilitation and regained self-care ability. Of all the patients,4 got a transitory fever and 2felt slight post-operation headache.CONCLUSION: Conclusion can be drawn from the study that stroke patients are ameliorated to various extents after neural stem cell transplantation which has no toxicity or side effects. It shows that neural stem cell transplantation is viable and feasible in improving the motor function and self-care ability in stroke patients.